URMC Prepares for Next-Generation Health Care Plans
Moves to Form New Organization to Manage Risk-Sharing Contracts
February 07, 2013
"The AHP gives doctors and hospitals a voice in shaping our destiny and sharing the satisfaction and rewards of health care that just works better."
The University of Rochester Medical Center (URMC) is seeking New York State Department of Health approval to form a new provider network whose members will participate in emerging payment plans that reward hospitals and doctors for better results and improved efficiency.
Once approved, URMC’s Accountable Health Partners (AHP), IPA, LLP, will be comprised of Strong Memorial, Highland Hospital, F.F. Thompson and possibly other community hospitals along with hundreds of faculty and private physicians. With a structure much like an independent practice association or IPA, the AHP will be key to establishing best practices and quality standards, and sharing savings from improved quality and efficiency.
“There’s no question that health care providers are facing a watershed moment. We can seize this opportunity to reinvent a health care system that both serves patients better and is sustainable for our children and grandchildren,” said URMC CEO Bradford C. Berk, M.D., Ph.D. “The AHP gives doctors and hospitals a voice in shaping our destiny and sharing the satisfaction and rewards of health care that just works better.”
Robert McCann, M.D. has been named interim Director and is charged with creating the AHP’s structure and building its physician membership. As a practicing clinician and pioneer of new delivery/payment models, McCann said that fellow clinicians need timely data that proves how health care dollars can be spent most effectively. Meshing insurance claims data with quality and outcome information gives doctors a clear view of what does and does not work, he said.
“Because our network spans primary, tertiary and quaternary care, the AHP offers the ability to tightly manage the broadest possible care needs right in our own system,” he said. “We are excited that the mix of academic and community physicians and hospitals will provide richly diverse, pragmatic ideas.”
Ownership of the AHP will be shared equally by Hospitals and physicians. Among the member hospitals, control is balanced to give the community hospital members, as a group, an equal vote with Strong Memorial. Likewise, control among physician members is equally split among URMC’s faculty doctors and community physicians associated with the member hospitals. Taken together, this creates a decision-making structure that requires consensus.
“The AHP – along with the restructuring of our own medical faculty group – is essential as we evolve to newer health plans and as traditional, fee-for-service plans recede,” said Raymond J. Mayewski, M.D. chief medical officer at URMC. “The AHP provides private practice physicians a seat at our table and we are eager to have them.”
With state health insurance exchanges set to launch in less than a year, the pressure is on to develop low-cost health plans. Whether sponsored by commercial insurers, provider networks, or hybrid plans co-branded by commercial payers and provider networks, it’s certain that the new plans will offer clear incentives for improving outcomes and efficiency. And, they will speed the movement toward sharing risk and gains with the providers caring for the plans’ enrollees.