By EWA MATUSZEWSKI
I get the sense I have written this column before. If I have, I approach this version with more vim and vigor and, admittedly, a bit of annoyance. The topic is physicians organizations, what they do, who they serve and what they are – and are not.
What they definitely are not, is new. I begin with this, because a respected Michigan business publication recently published an article about a physicians’ organization that formed to counter the efforts of large health systems trying to control their anesthesia specialty. Perhaps it was a beat unfamiliar to the reporter, but the article was written as if physician organizations were a new concept. Well, our organization has been around for more than 40 years, and I can attest that we were not the first. As a matter of fact, one of the reasons for founding our PO was because primary and specialty care physicians who immigrated to the U.S., and ultimately Michigan, were having a difficult time getting into other POs. We saw a need to help foreign-trained physicians blend in and set up and grow their medical practices. Today, our organization and other POs in Michigan – there are more than 40 – continue that mission with thousands of independent physicians, regardless of country of origin.
We are an advocacy group, representing member physicians who are consumed with the responsibilities of patient care and small business ownership and need an intermediary to advocate for issues important to their patients, their practices, and the medical profession on their behalf.
We are also a patient organization, focused on patient-centric care and community-based care. A PO is not a business model, but it does provide a payment mechanism and revue enhancement for its members. (Although increasingly that revenue enhancement comes with shared risks – but rightly so, I might add.) POs get paid by a combination of managing patient populations – with several POs exceeding 100,000 patients – for the best health outcomes and getting a share of the savings from quality initiatives. Money does not drive our decision-making, patient care does. Yet we work on behalf of our physician members to get appropriate reimbursement for their services.
I like to think POs are a friend to payors – and we are a friend to them. We pilot and implement a variety of primary care initiatives at their request within our member practices to improve patient care, notably for those with multiple chronic conditions that can be difficult to manage. It’s thanks to partnerships with payors like Blue Cross that the Patient-Centered Medical Home and Medical Home Neighborhood not only took root but are solidly planted and thriving in Michigan. Michigan-based payors like Priority Health, HAP, Meridian and Molina are currently working with POs to ensure initiatives such as care management/care coordination and integrated behavioral health in primary care are flourishing.
Although it’s not required, many physician organizations are entrenched in the community, bringing primary care to community centers, offering COVID vaccinations at pop-up events, and helping to operate health fairs for targeted groups. These services may be provided by physicians, but more often they are provided by clinical and support staff employed or contracted by physician organizations. One of our ambitious projects has been using two mobile clinics – one a refurbished bus, the other new – to take basic primary care services into underserved neighborhoods. It’s been quite a ride putting a clinic on wheels. (And yes, members of the MNO team now have a commercial driver’s license!)
Physician Organization is admittedly a bit of a misnomer, as some POs, like ours, also accept psychologists and other behavioral health specialists, chiropractors, physician assistants and nurse practitioners as members – generally, any clinical specialty that requires state licensure.
Combined, Michigan’s independent POs serve approximately 50% of the insured population. As health systems hire physicians directly or purchase physician practices as a business strategy, physician organizations are taking on greater importance for primary care and specialty care physicians who want to remain independent (self-employed) yet would struggle – or fail -in their attempts to do it alone.
I don’t think you’ve heard the last of me on the topic of POs (particularly considering the name of this monthly column!) because I just realized I didn’t mention infrastructure support, technology, learning events, and clinical management oversight. Indeed, POs aren’t new. But perhaps we need a brand refresh?!