Allen Daugird, MD, MBA, is president of UNC Physicians & Associates at UNC Health Care System and the new Triangle Physician Network, which was recently created to operate physician practices UNC Health Care is acquiring. Here Dr. Daugird lists nine aspects of hospitals' integration with physicians in North Carolina's Triangle Region, which is composed of Raleigh, Durham and Chapel Hill.
1. Stepped-up acquisitions. Triangle Physician Network, which UNC started in 2009, has about 100 physicians and expects to have 300 within 18 months. Two-thirds of the physicians will be in primary care, compared with only 15 percent nationally. "We need primary care physicians to make the system operate," Dr. Daugird says.
2. Regional competition heats up. The Triangle area has four major healthcare systems, which are becoming more competitive. For the two academic systems, Duke University Health System and UNC Health Care, strategies often mirror each other. Both systems bought a community hospital about a decade ago and Duke also has a community-based physician network. The non-academic challengers are WakeMed, based in Raleigh, and Novant Health, a multistate organization that moved into the Triangle area three years ago and started acquiring private practices.
3. Players anticipating ACOs. Major players in the region are moving toward accountable care organizations that will require systems to closely align with physicians to coordinate care. Dr. Daugird says UNC is very interested in new payment arrangements like ACOs. He says UNC is waiting for ACO regulations to be released, but it will quite likely launch an ACO. Meanwhile UNC is already in discussions with private payors to build ACO-like arrangements. UNC's interest in new payment systems comes from the top. The CEO of UNC Health Care System, William L. Roper, MD, was former head of HCFA, the precursor to CMS, under President George H.W. Bush. Dr. Roper has spoken in support of the healthcare reform law and its use of new forms of payment like ACOs.
4. Physicians look for systems to join. "A lot of private-practice doctors have gotten very anxious," Dr. Daugird says. Many of them have asked to join UNC, including a large heart group with 24 procedural specialists that will soon be part of the system. To set up EMR systems and deal with bundled payments, these physicians realize they need to align with one of the region's healthcare systems. "The managed care rates they can get through us are much better than they can get on their own," he says. "They have concluded they have to be affiliated with one system or another."
5. Referral patterns under stress. The migration of specialists and primary care physicians to divergent healthcare systems is disturbing current referral patterns. "Specialists are interested in bringing their referring primary care physicians with them," Dr. Daugird says. "If their primary care physicians join another system, the specialist will lose the referrals." Like many academic medical centers, UNC does not have a large primary care base, so it has had to build one up.
6. Integrating physicians. Triangle Physician Network is setting up an infrastructure for its community-based physicians. "We are solidifying an IT offering for physician practices we acquire," Dr. Daugird says. UNC has deep roots in EMR, having developed a system and sold it to Siemens a year ago, but physician practices need a different EMR system, which UNC has been installing for them. "We want to put all the practices in a common billing system," he says.
7. Growing areas of influence. "Originally we acquired practices in a 30-40 mile radius," Dr. Daugird says. "Now our practices are in a 100-150 mile radius." This requires new support systems. For instance, sending a UNC courier 50-70 miles away to pick up lab work may not be as efficient as contracting with an independent lab near the physician.
8. Little internal competition. Academic and community physicians have always lived in two different worlds, but competition for patients between UNC faculty and Triangle Physician Network is expected to be minimal. The primary care physicians function in small geographic areas untouched by UNC Hospitals. Specialists operate in a larger geographic areas that do overlap with UNC Hospitals, but have different interests than UNC's academic specialists. While UNC academics tend to be subspecialized, the community-based specialists generally cover their whole specialty.
9. More work needed when ACOs start. For now, newly acquired practices do not have to be well integrated with UNC, but that will change when ACOs start. "There would need to be more IT integration." Dr. Daugird says. "There would be a change from a fee-for-service culture that stresses volume of services to a new culture that stresses outcomes and quality. You can't have a bunch of siloed provider systems. Physicians will have to sit down and map out an ideal process of care. They would need to create guidelines for care and follow best practices. They would need to be committed to communicating with each other."
Read more about UNC Health Care System.
1. Stepped-up acquisitions. Triangle Physician Network, which UNC started in 2009, has about 100 physicians and expects to have 300 within 18 months. Two-thirds of the physicians will be in primary care, compared with only 15 percent nationally. "We need primary care physicians to make the system operate," Dr. Daugird says.
2. Regional competition heats up. The Triangle area has four major healthcare systems, which are becoming more competitive. For the two academic systems, Duke University Health System and UNC Health Care, strategies often mirror each other. Both systems bought a community hospital about a decade ago and Duke also has a community-based physician network. The non-academic challengers are WakeMed, based in Raleigh, and Novant Health, a multistate organization that moved into the Triangle area three years ago and started acquiring private practices.
3. Players anticipating ACOs. Major players in the region are moving toward accountable care organizations that will require systems to closely align with physicians to coordinate care. Dr. Daugird says UNC is very interested in new payment arrangements like ACOs. He says UNC is waiting for ACO regulations to be released, but it will quite likely launch an ACO. Meanwhile UNC is already in discussions with private payors to build ACO-like arrangements. UNC's interest in new payment systems comes from the top. The CEO of UNC Health Care System, William L. Roper, MD, was former head of HCFA, the precursor to CMS, under President George H.W. Bush. Dr. Roper has spoken in support of the healthcare reform law and its use of new forms of payment like ACOs.
4. Physicians look for systems to join. "A lot of private-practice doctors have gotten very anxious," Dr. Daugird says. Many of them have asked to join UNC, including a large heart group with 24 procedural specialists that will soon be part of the system. To set up EMR systems and deal with bundled payments, these physicians realize they need to align with one of the region's healthcare systems. "The managed care rates they can get through us are much better than they can get on their own," he says. "They have concluded they have to be affiliated with one system or another."
5. Referral patterns under stress. The migration of specialists and primary care physicians to divergent healthcare systems is disturbing current referral patterns. "Specialists are interested in bringing their referring primary care physicians with them," Dr. Daugird says. "If their primary care physicians join another system, the specialist will lose the referrals." Like many academic medical centers, UNC does not have a large primary care base, so it has had to build one up.
6. Integrating physicians. Triangle Physician Network is setting up an infrastructure for its community-based physicians. "We are solidifying an IT offering for physician practices we acquire," Dr. Daugird says. UNC has deep roots in EMR, having developed a system and sold it to Siemens a year ago, but physician practices need a different EMR system, which UNC has been installing for them. "We want to put all the practices in a common billing system," he says.
7. Growing areas of influence. "Originally we acquired practices in a 30-40 mile radius," Dr. Daugird says. "Now our practices are in a 100-150 mile radius." This requires new support systems. For instance, sending a UNC courier 50-70 miles away to pick up lab work may not be as efficient as contracting with an independent lab near the physician.
8. Little internal competition. Academic and community physicians have always lived in two different worlds, but competition for patients between UNC faculty and Triangle Physician Network is expected to be minimal. The primary care physicians function in small geographic areas untouched by UNC Hospitals. Specialists operate in a larger geographic areas that do overlap with UNC Hospitals, but have different interests than UNC's academic specialists. While UNC academics tend to be subspecialized, the community-based specialists generally cover their whole specialty.
9. More work needed when ACOs start. For now, newly acquired practices do not have to be well integrated with UNC, but that will change when ACOs start. "There would need to be more IT integration." Dr. Daugird says. "There would be a change from a fee-for-service culture that stresses volume of services to a new culture that stresses outcomes and quality. You can't have a bunch of siloed provider systems. Physicians will have to sit down and map out an ideal process of care. They would need to create guidelines for care and follow best practices. They would need to be committed to communicating with each other."
Read more about UNC Health Care System.