Policy Briefing Answering the Call During COVID-19 BY B I L L B A R C E L LO N A , E X EC U T I V E V P, G OV E R N M E N T A F FA I R S , A M E R I C A’ S P H YS I C I A N G R O U P S
Since the start of the pandemic, organized, provider-led delivery systems have been bringing more value than ever to the healthcare system. Below is a look at how value-based care has enabled physician groups to maintain viable provider networks, quickly adapt to stay-at-home orders, reach out to vulnerable members, and provide efficient care for COVID-19 patients.
MAINTAINING A VIABLE PROVIDER NETWORK In the early days of the pandemic (March and April), many physician offices had little if any patient volume. Providers contracted under fee-for-service (FFS) payment models had to shed administrative staff and then clinical staff—and in some cases temporarily cease operations altogether.
“Capitated
revenue enabled organizations to weather the patient volume downturn.”
Provider organizations that functioned on pure fee-for-service revenue streams were the hardest hit, and individual providers, even if employed, faced layoffs. Cash flow was significantly reduced, threatening financial viability. As these organizations contracted, the healthcare system faced lack of access. For smaller independent physician practices organized under sub-capitation, the story unfolded differently. Independent providers were sustained during the patient downturn and rebounded quickly as patient volume increased in May and June. Practices that were part of larger capitated organizations— multispecialty medical groups and independent practice associations (IPAs)—were sustained in the face of lower utilization and the loss of patient copay revenue through subsidies derived from the capitated revenue of their larger physician organizations. Providers learned that capitated revenue enabled organizations to weather the patient volume downturn, sustain access to care and administrative capacity, and avoid significant debt obligations after the downturn. Capitated organizations maintained a viable provider network for the healthcare system, while FFS-based models could not.
INNOVATING PATIENT CARE Our larger APG members quickly adapted to stay-at-home orders by expanding telehealth access. Many members organized telehealth implementation over a weekend or a work week, bringing thousands of individual physicians online to maintain patient access. Some APG members also began addressing the needs of vulnerable senior patients who were isolated during the lockdown. Through social service outreach programs, these member physician groups initiated patient calls to provide food, behavioral health counseling, and the simple act of human contact to express caring and concern.
16 l JOURNAL OF AMERICA’S PHYSICIAN GROUPS
Fall 2020
