There are also opportunities for physicians to play leadership roles in the development of risk-based products and ACOs. Andrew Dunn, MD, FACP, SFHM, chief of the division of hospital medicine at Mount Sinai Hospital in New York City, said he sits on a board of directors for Mount Sinai Care, the Mount Sinai system’s ACO, helping to guide its development of a shared-savings model of coordinated care.

The effects of hospitals entering the insurance business haven’t yet filtered down to the day-to-day work of hospitalists and emergency physicians, Dr. Dunn said, “but I’m sure we will be hearing much more about it. Mount Sinai has taken large steps in the direction of becoming an insurer, and the ACO is the best example of our increased focus on population health. The move for the health system toward becoming an insurer puts providers firmly in the camp where incentives favor quality, value, and efficiency.”

Physicians will still try to do what’s right for individual patients every time without asking whether they have fee-for-service or risk-based coverage, Dr. Dunn added. Physicians want to keep people out of the hospital, and if the systems are set up with incentives correctly aligned, they will try to make better use of discharge planners, social workers, home nursing care, and the like to help prevent avoidable readmissions, he explained.

“The move for the health system toward becoming an insurer puts providers firmly in the camp where incentives favor quality, value, and efficiency.”
—Andrew Dunn, MD, FACP, SFHM

Nick Fitterman, MD, FACP, SFHM, vice chair of hospital medicine for North Shore-LIJ, said his system’s efforts “are still in the early stages and really just an extension of what’s happening with value-based purchasing and at-risk contracts in general. We’re currently involved in six bundled-care initiatives.”

Dr. Fitterman agreed that these efforts haven’t had much impact yet on day-to-day medical practice in the hospital. However, the health system is preparing its physicians to participate in the insurance plan as if it were another bundled-care initiative. “We will be poised to expedite care and facilitate quality and marshal our forces as hospitalists,” he said. “What makes us excited is that the rewards will be much greater for providing good care efficiently.”

The hospital-based health system’s gains in efficiency from mastering risk-based coverage will be reinvested back into the system rather than sharing them with other payers, Dr. Fitterman said. “The vision I hear from our leaders is that they’re looking to get away from hospitals’ current narrow margins and let the system reap the rewards of providing efficient, cost-effective care.”

 References

1. Kliff S. Is this the end of health insurers? The Washington Post. July 5, 2013.
2. Garver R. Hospitals plot the end of insurance companies. The Fiscal Times. March 27, 2014.
3. Rabin RC. Hospitals look to become insurers, as well as providers of care. Kaiser Health News. August 26, 2012.

Larry Beresford is a freelance writer in Oakland, California.