ME: The big question: How can a smaller practice compete with larger practices under value-based reimbursement?
Zismer: To play to win in this environment, practices may have to do something many don't want to do—be part of that larger, more integrated, sophisticated health system that can go upstream while contracting with both insurance and the government.
The average health system has fewer than five payers that matter to the whole revenue stream in a major way. With such a consolidated payer marketplace, there really isn't a payer interested in trying to aggregate and contract separately with hundreds of small medical practices.
Payers are more attracted to larger, more integrated sophisticated systems of care delivery that have a more resilient economic model. Smaller practices should get organized and positioned to play in this era of experimentation, understanding that health insurance providers are interested in creating value-based programs. They may not, however, be interested in creating models and methods so that any provider of any size and scale can participate with them.
ME: With no "givens" yet with value-based reimbursement, can we "assume" anything now?
Zismer: To many professionals, this all feels like an experiment. They wonder, “How big do I have to be to be in the game and play at all?” and “Will any of these future experiments really help small practices?”
Truthfully, the governmental reimbursement system will be an experimental science for years to come. None of that is designed to help [small practice physicians, which] is really more of a partisan political issue.
The program will most assuredly not exclude practices, but it may get more expensive to participate, with more paperwork, more demonstrations and more data collection. This will continue to drive provider-side consolidation at an accelerated rate.