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Assessing options

Issues addressed in this case study include:

  • Moving a physician group from fee-for-service towards a value-based focus
  • Addressing physician compensation changes in a medical group
  • Forming a multi-organizational clinically integrated network (CIN)
  • Sharing finances in a CIN
  • Governing and managing a CIN
  • Providing the CIN’s infrastructure
  • Establishing relations with payers and health systems 

Seaside Medical Group was formed with the merger of three smaller groups ten years ago. The group has added two new small primary care groups in the past two years. Seaside now has 380 providers (310 physicians). The group includes multiple specialties (the current make-up is 58% primary care, 42% specialists). The group is highly regarded throughout the state.

Four years ago, Seaside decided to move aggressively towards population health management. The group’s president noted, “If we do nothing, our reimbursement will simply go down each year for most RVUs. If, on the other hand, we could work to take and manage the physician—and maybe even the hospital and pharma—portion of the premium dollar, we could control our own destiny.”

Seaside leaders knew there were risks. However, this seemed to be the course with the best chance to maintain Seaside’s position as a lead provider organization in its market. Seaside’s president also sought to eliminate silos in clinical information: “Some people think that information is power—this is just wrong. Shared information is what generates positive outcomes.”

Seaside’s leaders visited several other groups that were working to be leaders in population health management. They recognized that they would need a new infrastructure in order to make this happen. They also recognized that a substantial investment would be required to build this infrastructure.

Assessing options 

Key issues for Seaside in moving forward in population health were: 

  • Where to get the required investment capital 
  • How to accumulate the optimal patient population

Seaside’s leadership considered four approaches to accessing the funds to invest in population health management infrastructure:

  • Joint venturing with a health system
  • Joint venturing with a payer
  • Teaming with a venture capital firm
  • Borrowing the funds

Seaside ultimately decided to joint venture with a payer. The payer was a co-investor in a joint venture company to own the infrastructure. This payer was also the physician group’s first value-based payment contract.

Next, the group looked for other physician groups to join in spreading the overhead cost and in assembling a larger patient population. Some groups were invited and accepted proposals to merge into Seaside. Other groups were not considered to be good merger candidates, or were already owned by area hospitals, but were still good candidates to participate in a CIN. 

Seaside and its joint-venture partner established a management services organization (MSO) to provide electronic medical record support, claims and EMR data analysis, and other support services. 

Seaside Medical Group recognizes that both the medical group and the CIN will evolve over time. Other issues continuing to evolve include: 

  • Culture: emphasizing the need for a more team-oriented approach to care
  • Analytics: defining specific care populations and treating them in a consistent manner
  • Compensation: incentivizing quality and cost-efficiency as well as productivity
  • Payer contracts: seeking increased value-based contracts
  • Finances: determining distribution of revenues within the CIN

Tool: Example of a CIN’s Revenue Distribution Model

Seaside’s network has expanded to cover a 10-county area. A new entity, Lowlands ACO, has been formed. Seaside’s president notes, “We are not sure the ACO is going to be a big financial success. However, we like having the legal position of being an ACO, which clearly helps establish that we are providing clinically integrated care. This also covers a patient population that would otherwise be hard to reach.”

Seaside and its partners now are involved in value-based contracts, including

  • 4 commercial contracts
  • 1 gain-sharing ACO
  • 3 Medicare Advantage contracts
  • 1 narrow panel option with a health plan on the state exchange

“We are still learning,” noted Seaside’s president. “And we are likely to be on a fast learning curve for several years. But we appear to be on the right track. We also believe we are doing the right thing for patient care. In the meantime, we like our bonuses, and it sure is easy to recruit.”

Assessing options

The case study talks about a company by the name Seaside Medical Group which is a health-based company. The said company was formed as a result of a merger where three different groups came together. It happened some ten years ago and grown significantly to adding two smaller units. The company's purpose before the merger was to protect from going down for most RVUs. Despite there being risks in the approach, the management sought information from other groups, and hence, they realized there was a need to change several issues. In this revolution, the company used various options that would help in the revolution. There was consideration ion where they were going to source capital to accommodate patients, among others. After all these evaluations, the company decided to go forward in evolution, which would take time.

From the case study, we can analyze that the company seaside medical group was not performing well before its evolution. After the merger, the number of physicians increased tremendously to 310. It became highly regarded in the state with 58% and 42@% primary care and specialist, respectively. In the course of its revolution, the company outsourced information, and hence it eliminated silos that formed part of its clinical data.

Concerning the need for capital for its investment and expansion, several measures were taken to help source the capital. The management opted to go for joint ventures with other health providers, playing teamwork with other capital ventures a borrowing. In solving the issue of the large population, other physician groups were looked into to spearhead the overhead cost. A management service organization was developed to offer support services and keep EMR dart analysis

These factors helped the grouping its development which they also realized it was to take a reasonable duration of time. Besides this, there was a need to implement other t factors in the course of development; these factors included; insisting on the workers, they need for teamwork. A strategy was also developed to help treat its large population. Finances were well distributed within the CIN and quality contracts awarded.

Seaside Medical Group has now developed and has been able to cover a 10-county area. Besides that, there was the formation of a new entity known as Lowlands ACO. The Group, together with its key partners, are involved in various value-based contracts, which include; gain- sharing ACO and four commercial agreements, among others (Chamekh, 2019).

The tools used by the Seaside health group included "a care networks population health tool." The tool helped in recognizing the need for individual health conditions and surrounding environmental conditions in maintaining and promoting health. The other tool included "a CIN's Revenue Distribution Model."

Conclusion

From the case study so seaside Medical Group, we can conclude that a merger among key groups praying the same role can help in reconstruction. The Group sought to allay with other groups in the health sectors to avoid going down every year for most RVUs. By taking measures of merger a carrying out market analysis to see on the areas of improvement, the Group was able to grow tremendously. The Group was able to achieve on changing its physician group to a value-based focus as it was initially a free-for service. The Group was also able to establish relations with other key players. From this case study of the seaside Medical Group, we can conclude that a merger among various groups can help in the rebuilding of an organization.

Regarding the case study of the seaside medical Group, I would recommend that appropriate management should be put in place to help sustain the merger. Through active management, it will help ensure that there remains a strong bond among the different groups that came up during the merger. Effective management will help sustain the achieved goals which had been initially set by the groups. To avoid conflict of interest, the groups also need to have set regulations that will help in their rules (Smith, 2015). The steps taken in the case study to help revive the seaside Groups are viable and of great importance, which can be recommended for another company experiencing the same challenges.

How did the management of seaside medical group work towards moving its physicians from serving for free into having value for their service?

Why did the Seaside group work towards forming an integrated network to be used by its clinicians?

How is the doctor's reimbursement alterations in the company addressed?

References

Chamekh, M. The Interplay of Health, Pleasure and Wellness in British Seaside Resorts: the Case of Skegness on the Lincolnshire Coast. Revue Française de Civilisation Britannique. French Journal of British Studies, 24(XXIV-3), (2019).

Smith, M. Baltic health tourism: Uniqueness and commonalities. Scandinavian Journal of Hospitality and Tourism, 15(4), 357-379, (2015).

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My Assignment Help. (2020). Seaside Medical Group Essay: Population Health Management Focus.. Retrieved from https://myassignmenthelp.com/free-samples/hcmg420-healthcare-finance.

"Seaside Medical Group Essay: Population Health Management Focus.." My Assignment Help, 2020, https://myassignmenthelp.com/free-samples/hcmg420-healthcare-finance.

My Assignment Help (2020) Seaside Medical Group Essay: Population Health Management Focus. [Online]. Available from: https://myassignmenthelp.com/free-samples/hcmg420-healthcare-finance
[Accessed 26 May 2024].

My Assignment Help. 'Seaside Medical Group Essay: Population Health Management Focus.' (My Assignment Help, 2020) <https://myassignmenthelp.com/free-samples/hcmg420-healthcare-finance> accessed 26 May 2024.

My Assignment Help. Seaside Medical Group Essay: Population Health Management Focus. [Internet]. My Assignment Help. 2020 [cited 26 May 2024]. Available from: https://myassignmenthelp.com/free-samples/hcmg420-healthcare-finance.

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