Keynote Address: Navigating Health Care Disruptions

At the 2021 Fall Managed Care Forum, John Harris, MBA, managing director of the health care management consulting firm Veralon, delivered the second of two keynote addresses, focusing on strategies for managing health care disruptions without fragmentation.

To start his presentation, Mr. Harris outlined the current “battle” among health systems, physician aggregators, and purpose-built primary care models to provide highly coordinated, high-value care to patients.

He then described health care delivery within a health system model (sponsored by a clinically integrated network, accountable care organization, or high performing network [CINs/ACOs/HPNs]), which brings together many components of the continuum – from acute care to freestanding outpatient clinics – within one organization. However, Mr. Harris noted that this “full-service” model “lacks unique solutions for population segments, creating care that is not fragmented, but not often customer-friendly.” He added that some services (e.g., outpatient) are much more expensive than market alternatives.

On the other hand, physician aggregators, which incorporate several independent physician practices, are not fully integrated with hospital services. They offer more coordinated than independent practices, but often only provide primary care services.

In comparison, the purpose-built model delivers more comprehensive primary care. This model provides highly coordinated within their range of services, and, although these practices are less integrated with hospital care, which may be critical for next level of performance. Their focus on Medicare and dual Medicare/Medicaid patients may open door for cooperation with health systems, Mr. Harris added.

Other potential sources of fragmented care include direct-to-consumer virtual vendors, retail clinics, and urgent care centers.

Looking to the future, Mr. Harris raised questions about the long-term fate of physician aggregators and physician employment by health systems. In the case of sponsored health systems, he said, many physician groups with better value-based care performance will likely be wooed away to physician aggregators, leading to the question of whether CINs/ACOs/HPNs will be able to hold onto their networks?

He recommended several strategies for health systems responding to threats from physician aggregators, such as “fight” (countering buyout offers and continuing the value journey) or partnering with physician innovators to bolster business.