NCMS Morning Rounds 7-1-21

Happy Thursday! Enjoy your NCMS Morning Rounds.

July 1, 2021

Today’s the Day – Medicaid Managed Care Is ‘Live!’

The long-awaited transition to Medicaid managed care in North Carolina happens today. In advance of this change, the NCMS and our partner organizations have a webpage with valuable resources to help your practice have a smooth transition as well as a special form on which to register any persistent problems. Visit the Medicaid Transformation webpage here.

The NCMS along with the NC Academy of Family Physicians, the NC Pediatric Society and the NC Psychiatric Society issued a joint media statement yesterday on this momentous change. Read the statement here.

New Study Shows 70 Percent of Physicians Nationwide Now Employed 

Nearly 70 percent of U.S. physicians are now employed by hospital systems and corporate entities like private equity firms and health insurers according to a new study by Avalere for the Physicians Advocacy Institute (PAI) examining the two-year period between Jan. 1, 2019 and Jan. 1, 2021.

The research found the COVID-19 pandemic accelerated a long-term national trend of hospitals and

corporate entities acquiring physician practices and employing physicians. During the two-year period studied, these entities acquired 20,900 additional physician practices. Forty-eight thousand additional physicians left independent practice for employment by hospital systems or other corporate entities.

“COVID-19 exacerbated financial vulnerabilities of physician practices and forced them to make difficult

decisions,” said Kelly Kenney, chief executive officer of PAI. “The practice acquisition trend has

potentially serious implications for competition and health care costs, which have been shown to increase with this type of marketplace consolidation.”

Every U.S. region experienced these national trends of steady growth in employment and acquisitions,

with an uptick in the last half of 2020. The study also looked at data for individual regions of the US, revealing that the South has the highest percentage of corporate employed physicians at more than 23 percent and had the biggest increase in physician employment with more than 40 percent growth. Our region also experienced the biggest increase in practice acquisitions by corporate entities with 59 percent growth.

The cumulative findings by Avalere researchers during the two-year period revealed:

• Hospitals, health systems and corporate entities now own nearly half of the nation’s medical

practices.

• The sharpest increase in physician practice acquisitions and employment was among corporate

entities such as private equity firms and health insurers (32 percent).

• Across regions, hospital ownership of practices grew between 6 percent and 11 percent and

corporate ownership grew between 44 percent and 59 percent.

Find a brief overview of the key findings of the study here. More information also is available in this slide deck.

PAI highlighted the findings in a letter to Congress and has pledged to work with Congress and state policymakers to champion policies that enable physician-led organizations and independent physician practices to compete with larger corporate entities to deliver health care services to patients.

“Regardless of the practice setting, physicians must retain autonomy to make clinical

decisions, free from interference by corporate entities motivated primarily by profits,” said Kenney.

PAI and the NCMS, which plays an active role in PAI, are examining these trends as part of an ongoing effort to better understand how physician employment and health care consolidation affects the practice of medicine as well as implications on health care costs and spending. Watch your NCMS Morning Rounds for further analysis of this valuable information.

New Blue Cross NC Joint Venture Aims to Help Independent Practices

Earlier this week, Blue Cross and Blue Shield of North Carolina (Blue Cross NC) announced a new joint venture with Deerfield Management Company, a health care investment firm, to provide services to support independent physician practices and help them succeed in the move to value-based care. The venture will leverage Deerfield’s research and operational capabilities, such as the Deerfield Institute and its External Operations Team, and represents the next phase of Blue Cross NC’s efforts to work with providers “to make health care better, simpler and more affordable,” according to a Blue Cross NC press statement.

“Independent physicians in North Carolina have an especially difficult burden when it comes to managing their practices without the resources and scale that come with being part of a larger organization,” said Tunde Sotunde, MD, Blue Cross NC president and CEO, in the official statement. “We want to empower independent physicians – especially primary care – by offering a new level of support to help them lead their practices in a time of great change in health care. This new organization will fill a void for practices that are independently owned and will help them thrive.”

Deerfield partner Adam Grossman added: “We are excited to join forces with Blue Cross NC, a national leader in the transition to value-based care, in our shared vision to create an organization that supports and strengthens independent providers. This joint venture aims to improve access to high-quality primary care while ultimately reinforcing the importance of the provider-patient relationship.”

The new venture will:

• Provide infrastructure and support services to reduce administrative burdens and alleviate physician burnout
• Equip physicians with integrated technology solutions to monitor, manage and coordinate patient care effectively
• Share data and insights alongside value-added services to identify and address opportunities to improve care
• Offer flexible options to help physicians structure the management and ownership of their practices

In the News

3 New Studies Shed Light on Big Questions About Covid-19 Vaccines, Advisory Board, 6-29-21

Learning Opportunity

Toolkits for Racial and Ethnic Minority Communities, TODAY, Thursday, July 1st, 1:00-2:00 pm ET

The HHS We Can Do This campaign is a national initiative working hand in hand with trusted leaders and community organizations to continue to build confidence in COVID-19 vaccines and get more people vaccinated. This campaign offers tailored resources and toolkits for stakeholders to use to provide COVID-19 vaccine information to at-risk populations.

The Centers for Medicare & Medicaid Services (CMS) is partnering with the campaign to offer several webinars to walk through each toolkit and its resources and train community organizations, local voices and trusted leaders to use the campaign tools for vaccine outreach efforts to diverse communities.

Register here.

If you have policies you'd like your NCMS Board of Directors to consider, please complete the Board input form here. Thanks for reading!

by Joy Avery