March 1, 2023

"Physician Enablement Companies" Allow Small and Independent Physicians to Compete

Back in the day, a bunch of us expended a lot of effort, creativity, and collaboration to streamline and standardize the electronic claim transaction(s) for healthcare. The idea was to have such a rigorous data specification, it could meet the needs of every US payer for every US physician, lab, hospital, clinic, or facility. It got us past the days when health plans could use their own numbering systems for practitioners and organizations, or insist on using their own "local codes" for certain procedures or charges.

Pretty cool, huh? We saved billions of dollars and billions of trees by moving the lion's share of healthcare administrative transactions to electronic formats. In fact, for claims, remittances, eligibility, and enrollments, the HIPAA standards were the ONLY legal way to transmit. Health plans had to accept ANY valid claim, from any size healthcare provider.

Everything was hunky dory for about a minute.

Then came value-based care. Or, more to the point, value-based reimbursement. All of a sudden, providers were "invited" to take on some of the risk traditionally borne by private insurers and public health plans like Medicare and Medicaid. If they could prove they saved money (I mean "improved outcomes regardless of cost"), they got a piece of it. Every month seemed to bring a new pilot program, each with its own, relatively unregulated reporting requirements. Negotiating a worthwhile contract or administering a profitable approach required new sets of skills, from technical to clinical to actuarial.

In other words, small providers, hospitals, and clinics took a hard shot to the bottom line.

Into this black hole rode a new breed of white horse. The Physician Enablement Company. Our friends at Fierce Healthcare tell a story of one such company, Privia Health

"The company's strategy is to partner with providers by setting up a single tax ID entity that facilitates payer negotiations and clinical alignment while maintaining a provider’s legacy ownership structure. It also organizes ACOs for risk-bearing value-based contracts and provides its tech and services platform."

The article also mentions other companies in the space, including Aledade, Vytalize Health
and Pearl Health.

"The movement of value-based care is long overdue and primary care providers and community providers are on the forefront of that movement," [Parth Mehrotra, Privia Health President and CFO] told Fierce Healthcare recently. "I am generally surprised that a lot of consolidation hasn't happened and people haven't caught up to UnitedHealth and what they've done with Optum. I think you're seeing a lot of that catch-up happening now from a strategy perspective," he said.

If your organization has a need to identify and contact US physicians, you might consider our Authoritative Physician Database™. We start with data we extract monthly from the CMS NPPES system, the "single source of truth" for practicing physicians, hospitals, and other healthcare providers. We then aggregate or derive further data and metadata, resulting in 1 million+ U.S. Physicians with specialties, practice group & hospital affiliations, graduation year, payments, phone, fax and more.

We also recommend letting Lowell and the Feat play you out.

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