Super Groups Might (or Might not) be the Answer to Value-based Reimbursement

The healthcare environment is evolving at a rapid pace, complicated by larger legislative changes and the introduction of new models like value-based reimbursement. The traditional fee-for-service (FSS) system is becoming irrelevant. For many providers and physicians, the challenge in this new healthcare landscape is to remain independent while finding support and likeness in a larger group. Creative new partnerships continue to emerge as the healthcare system transitions over to value-based reimbursement, including Integrated Group Practices and physician supergroups. 

A physician supergroup, or Integrated Group Practice (IGP) is a group of physicians or physician practices. They are usually comprised of at least 20 physicians, all under the same tax identification number. Although IGPs are thought of as a single entity, they usually include a number of care centers or office locations. 

IGPs put doctors in an advantageous position to face the challenges of today’s healthcare market and current economy in the following ways: 

  • There’s power in numbers, and an army of physicians can better negotiate insurance reimbursements, hospital contracts, and employee benefits.
  • Similarly, an IGP may have more power to negotiate malpractice premiums.
  • When compared with a sole practitioner or physician practice, supergroups can often manage administration — like billing, HR, and vendor negotiation — with ease.
  • Centralized expertise can be leveraged to optimize collections, patient care, and practice building. 
  • For physicians planning for retirement, some supergroups have a buyout provision while sole practitioners have to worry about selling their practice. 

Value-based reimbursement, one of the most recent trends in healthcare, dovetails nicely with the increasing number of IGPs. Exchanging and storing data in one centralized location helps physicians dilute risk and generally lower healthcare costs. Comprehensive delivery from an IGP is beneficial from the perspective of insurers, physicians, and patients. And, as a consequence of a single cohesive organization, patients can have faith that their health information is protected and secure. Largely, supergroups (or IGPs) are able to drive down costs while achieving efficiencies of scale. 

To create a supergroup or IGP, a variety of questions must be asked and answered, including: 

  • How can we leverage expertise across the entire network?
  • What existing programs should we continue to support?
  • What patient portals and communication platforms will keep patients informed?
  • How are we going to provide a total experience for the patient?
  • What are the most important outcomes to track and measure? 
  • Are there gaps in care that need to be filled? 
  • How will the creation of this group support value-based payment models? 

Physicians and providers will continue creating new mergers and acquisitions in response to the demand for value-based payments. The benefits of a joint venture include an environment where creativity and innovation thrives. Related financial relationships and complex legal and regulatory issues further complicate marketplace transactions, which is to be expected across the entirety of healthcare. However, the groups that manage to acquire strong leadership, build a growing patient population, and deliver quality care, will be competitive in today’s healthcare landscape.