The PA Clinical Network is the only clinically integrated network in the country sponsored by a state medical society. In a recent interview, John Pagan, M.D., the Pennsylvania-based organization’s CEO and chair, discussed its experience in value-based care arrangements and a new partnership with technology-driven health services platform company Guidehealth.
Also joining the conversation was Dallas-based Guidehealth Co-founder and CTO Michael Gleeson, who previously served as chief strategy and innovation officer at Arcadia. Last year, Guidehealth acquired Arcadia’s managed services organization (MSO) and value-based care service division. Gleeson’s co-founder and Guidehealth’s CEO is Sanjay Doddamani, M.D., formerly the CEO of Upstream Health, which works to embed prescribing pharmacists and coordination nurses into primary care practices. Previously, Doddamani, was chief physician executive at Southwestern Health Resources in Dallas, a senior advisor to the Center for Medicare and Medicaid Innovation (CMMI) and a chief medical officer at Geisinger.
Healthcare Innovation: Dr. Pagan, when did the PA Clinical Network form and why?
Pagan: We started about a decade ago, when there was a lot of talk about changing payment methodology, and physicians going from volume to value-based care. The medical society wanted to make sure that their doctors were well versed in that and were able potentially to lead that transformation rather than just follow along, because even well-meaning politicians and administrators sometimes can take the whole thing astray because they don't have the general knowledge of actually caring for patients in the process.
HCI: And this is pretty unusual for a state medical society to be involved in the formation of a clinically integrated network, right?
Pagan: To my knowledge, this is the only state medical society-sponsored clinically integrated network and ACO. A subset of our clinically integrated network consists of a group of primary care doctors who joined together as as an accountable care organization and we are participating in the Medicare Shared Savings Plan or MSSP.
HCI: You mentioned starting about 10 years ago. How big has the network grown and is it a mix of primary care and specialists?
Pagan: In the ACO we have about 35 practices. in the PA Clinical Network we have about 60 practices. It's predominantly primary care. We do have a number of specialists. The way that value-based care works now, the majority of our arrangements are primary care-focused. Our specialists are enlightened. I think they're ahead of the curve and they're anticipating what CMS and others will be doing in terms of bringing specialists into the equation.
HCI: What are some of the biggest challenges that independent practices face when they're trying to get involved in value-based care arrangements? And in Pennsylvania has it become increasingly difficult for the practices to remain independent?
Pagan: I don't know if Pennsylvania is much different than than other areas except that Pennsylvania does have some very, very large health systems and an increasing number of mergers and consolidations, so there is a squeeze on independent practices. Independent practice are a little bit isolated and disconnected. In terms of value-based care, having the size that would make a value-based arrangement palatable or interesting for any payers is a challenge and also having access to the data to prove that the good care that you're giving is indeed good care. Having the data infrastructure to be able to present the improved care you're giving is certainly hard. Our network allows an overall umbrella or cohesion to that as well as providing some infrastructure that they can't get on their own.
HCI: Michael, if you look across the country, do you see any other issues that smaller or independent practices face trying to get in the value-based care realm?
Gleeson: I would echo what Dr. Pagan said and then I would add that both on the data front and the technology front, you need some sort of supporting entities. Paying for and delivering that on an individual practice level is a difficult amount of money to cover, and it makes more sense to do it holistically across a broader set of organizations or to have someone else who can support that across other provider groups. If you talk to anyone involved in value-based care, you know, there's an administrative burden. How do you get some additional labor and support to offload that and augment the practice versus pushing technology into the practice, having them click through more screens.
HCI: In terms of value-based care contracting, are there big differences state to state? Are the commercial payers and Medicaid MCOs in some states more advanced and better at working with clinically integrated networks than others and if there is a difference where does Pennsylvania stand?
Pagan: I can speak only from my experience in Pennsylvania. We have seven commercial payers and contracts. The degree of opportunity does vary from payer to payer. Some of them are a little bit more robust and savvy than others. And likewise, you see that distribution across the practices as well. Also, we see variations in terms of quality measures with each payer, which makes it increasingly complex for the small practices to keep up with that.
HCI: Can Guidehealth help the network with pulling data together from a variety of EHRs to do the quality reporting or to do predictive analytics on rising risk and send suggestions to physicians about what they should be working on?
Pagan: That is certainly one of the long-term opportunities for us, and we are looking forward to that in our partnership. We already give our docs a lot of helpful tips, both on which patients to focus on and which gaps are still out there. We do a lot of that administrative stuff behind the scenes to support the practices. However, we don't have the resources or the infrastructure to actually take that next step further to the patient. Most of these practices, especially post-COVID, are fairly strapped resource-wise, so the most exciting thing for me and for our doctors is that Guidehealth will in a virtual manner support and extend the office for each of these practices to be able to better reach and touch the patients between their visits. And in patients who are fairly complex and have a number of issues, they are able to track them and also make sure that whatever testing is necessary, whatever medications are necessary, that that can be done without further straining our practices, which are small businesses. These mom-and-pop shops are running at full tilt.
HCI: Michael, can you talk in more detail about that aspect that Dr. Pagan just mentioned?
Gleeson: Your question about the ability to to aggregate the data and deploy it for quality as well as predictive analytics is a key part of the underlying value that we bring to our customers. The other thing that Dr. Pagan mentioned is the opportunity for using a central services provider like Guidehealth, where we work with multiple different technology vendors and can shift that around depending on what works best for a given market. If there's more ADT coverage from one particular national party or an ADP vendor or an HIE, we can make sure we get that connected.
Our Healthguides, who are certified but non-licensed professionals like an MA or an LPN, allow us to extend the practice. They have a longitudinal relationship with the practice and get to know the team there. They have long-term relationships with the patient, which means that you're getting a phone call from somebody you know checking in on your care plan. We have processes to get that care plan signed off on by the practice and then ensure compliance and engagement and really help make sure that activities happening outside of the four walls of the practice are occurring as expected. In a normal practice setting, there are not the resources to do that. They're just not structured that way. We provide that resource and it is funded ultimately through the performance payments generated by improved patient outcomes and reduced medical expense.
HCI: Michael, do you think that Guidehealth will look for other clinically integrated networks like this one to partner with across the country?
Gleeson: Well, as was mentioned earlier, there is only one exactly like this one. But yes, we will be looking for other clinically integrated networks —both stand-alone or attached directly or loosely to hospital systems, as we continue to grow this model in the market and bring more predictable and sustained success in value-based care out to more physicians across the country and more patients, frankly.
