Success now contingent upon innovative value-based contracting, cost and quality incentive provisions with additional risk, and telehealth
NOVI, Michigan, August 12, 2022 – The American Medical Association (AMA) recently featured industry expert Mike Grodus in its ‘Thriving in Private Practice’ podcast series. Grodus is Director of Healthcare Transformation at Medical Advantage and actively manages a successful physician organization and ACO, Professional Medical Corporation (PMC) and PMC ACO, in Flint, Michigan.
During the podcast episode, Grodus noted that the financial success of an independent physician is now largely dependent upon its ability to creatively negotiate payer contracts to maximize financial success. He explains that payers generally have a commercial, Medicare Advantage, or Medicaid product, and each has different parameters for negotiating the best deals. A good contract is the foundational piece necessary for maximum financial success for the physician organization and its physician members.
“There are different contractual terms and value-based provisions in a Medicare Advantage contract that you can negotiate versus a Medicaid versus a commercial contract. You really have to understand the different products and opportunities within each product that are out there,” Grodus states.
Another important key trend Grodus points out is that employers and health plans are seeking more risk-based contracting with the physicians and physician organizations, with the goal of improving quality while lowering costs. The movement toward value-based risk contracts shifts more financial risk to the physicians. He cautions that without the right administrative structure in place to effectively guide the physicians through these programs, there is potential to have “multi-millions of dollars left on the table.”
The third trend that Grodus identifies is the adoption of telehealth. He advises that a physician organization (PO) can provide critical assistance to practices. “We have a number of resources who understand telehealth and actually work with a number of our practices to aid them and assist them into getting the technology – and understanding the technology – and how to get set up for telehealth,” he says.
At the end of the podcast, Grodus is quick to point out the multitude of challenges for physicians who wish to be independent as they compete against large health systems with employed physicians. However, he also sees the light at the end of the tunnel and shares his optimism with independent physicians who may be struggling, as there still are significant opportunities for the independent physician.
“There are opportunities. There is hope. Don’t feel defeated. You will find a path. You’ll find a way, and you have opportunities to remain independent and still do well and keep your practice that way,”
Grodus affirms.
To hear the full podcast, visit https://www.ama-assn.org/
About Medical Advantage
Medical Advantage (medicaladvantage.com) is an innovator within the TDC Group of companies (TDC Group) for maximizing health plans and physician clinical and financial performance in value-based contracting. Medical Advantage’s hands-on, value-based healthcare, electronic health record (EHR), healthcare performance dashboards, and telehealth consulting services provide practices, health plans, and delivery systems of all sizes with customized, actionable solutions to decrease the cost of care and improve quality. Medical Advantage’s mission is to simplify the delivery of efficient, high-quality healthcare.
Media Contact:
Allison Solit, Director of Marketing
517.889.5767
asolit@medicaladvantage.com
