Virginia-based Privia Health recently launched in Texas and features a nationwide network of over 1,600 physicians. The network’s goal is to keep physicians independent by building high-performance physician groups and clinically integrated provider networks. In 2014, a Goldman Sachs-led group invested $400 million in Privia.
Last month, the Centers for Medicare and Medicaid Services (CMS) announced the Medicare Shared Savings Program results for 2015, and Privia Quality Network ranked in the top 7 percent of all accountable care organizations (ACOs) for total earned shared savings payment. It also ranked third among ACOs that are in the second year of operations.
Dave Rothenberg joined Privia Health as its president in 2010. Prior to joining Privia, Mr. Rothenberg founded MDLinx, which is a physician-focused healthcare media company that became the second largest online physician network in the nation after WebMD. MDLinx was acquired by a division of SONY.
The following is a Q&A that TOA recently conducted with Mr. Rothenberg.
TOA: We are witnessing an increasing number of anesthesia groups that are forming national groups. Is Priva following a similar path?
Dave Rothenberg: Privia Medical Group is purpose-built to help small, medium, and large practices get into and succeed in performance- and risk-based contracts while keeping their autonomy. We align ourselves with the very best primary care practice and medical specialists who treat high-cost, chronic patients. In North Texas, we have aligned with Texas Healthcare, a leading practice of 200 providers, so we can offer specialist and sub-specialist care. Using teams, technology, analytics and proven population health strategies, we work together to better support patients and drive better outcomes. Privia Medical Group is different than many single specialty groups, in that we care for the patient across the full continuum of care, rather than just an episode of care. This approach allows Privia to form partnerships with payers that reward physicians for the value they drive to their patients and the overall healthcare system.
TOA: What was the impetus behind forming a nationwide physician group like Privia?
Dave Rothenberg: Privia was established on the belief that we can change healthcare to what it ought to be, for patients and physicians alike. Our focus has been to put physicians back in the driver’s seat, where they haven’t been in a long time, to lead this change to provide quality care while removing unnecessary costs from the system. By taking on the heavy administrative load of population health programs and payer contracting, Privia allows doctors to get back to being doctors again and focus on their patients.
This shift from fee-for-service to value-based reimbursement models has created a need for independent physicians to find a partner who can provide the support necessary to succeed. Great doctors can provide clinically exceptional clinical care during an office visit, but in order to support the health of a population, doctors need additional resources including technology, workflows and support staff. They need teams to work with patients between visits, transportation solutions for indigent and chronically ill patients, as well as hospitalists and extensivists to see them in acute care settings. Privia is able to provide the support doctors need to succeed in the new world of value-based care.
TOA: How does Privia interact with specialists in other states?
Dave Rothenberg: Privia is a data-driven organization with a focus on quality, outcomes, and patient satisfaction. We look to partner with like-minded specialists who can provide the highest quality, cost effective care. We invite top specialists into the group that manage chronic patients such as endocrinologists, pulmonologists and cardiologists. Currently, these specialists make up 25 percent of our providers.
TOA: Is Privia leading new payment models such as ACOs?
Dave Rothenberg: Yes, we are leading new payment models. We have Medicare Shared Savings Programs (MSSPs) and have formed commercial ACOs in our current markets of Texas, Georgia, Virginia, Maryland, and DC. Our Medicare ACO recently received a quality score of 98 percent, ranking us third against all ACOs nationally, in their second year of operation. This is not easy and there are no short cuts. There is a reason why 70 percent of ACOs in 2015 have not generated payments to their doctors. Privia has a proven model for success and it starts with aligning with the right primary care physicians.
TOA: How are hospitals reacting to Privia?
Dave Rothenberg: As a part of an integrated healthcare delivery system, hospitals are critical Privia partners. We align with hospitals that provide high-quality and cost effective care. We share and receive data with many hospitals in order to support and improve care for our patients.
If a hospital’s strategy is to expand their ownership of physician practices, we sometimes compete with them for primary care practices. However, because our models are so different, physicians are typically not choosing between Privia or a hospital. Privia enables practices to retain a fair degree of autonomy in their own practice, while many doctors choosing hospital employment are typically looking for someone else to take over most aspects of their practice. The reality is that to manage the health of populations, you need to work with hospitals and we work very hard to build those partnerships.
TOA: Has Privia been able to pull primary care physicians away from existing hospital-employment contracts?
Dave Rothenberg: Privia does not interfere with employment contracts between physicians and hospitals. We have been approached by physicians who are not satisfied with their situation and are looking for different opportunities. Privia is a good solution for these practices because we provide the infrastructure a practice needs: quality partnerships with payers, a technology platform, a population health platform, billing and collecting support, consulting, marketing, etc.
TOA: What has your experience been like in the Texas market?
Dave Rothenberg: Privia has had great success in Texas. Physicians here are hyper-aware of the shift to value and have been participating in Medicare Advantage and ACOs. We are talking to a very informed physician community. Since costs are very high in Texas, and so much burden is falling on patients with high deductible plans, we see a real opportunity to help decrease the unnecessary costs these patients face. Dr. Keith Fernandez, previously the CEO of the most successful ACO in the country, has joined Privia as a Senior Physician Executive and I think that alone is a powerful statement. Dr. Larry Tatum, a well-known and well-respected ObGyn in Fort Worth is one of the leaders of Privia Medical Group – North Texas. We have nearly 300 providers in Texas already, and it’s just our first year in the market.
TOA: How are commercial insurance plans reacting to you?
Dave Rothenberg: Generally health plans treat us as their partners. We sit on the same side of the table, look at all the unnecessary costs in the system, and design partnerships where everyone gets rewarded: patients with lower bills and better health outcomes, physicians with better reimbursements, payers and employers with more manageable healthcare costs. In the past, payers and doctors were rivals fighting over the level of fee-for-service reimbursements. However, with the move from fee-for-service to performance and risk arrangements, physicians increase their income and payers reward for better outcomes. Privia knows that all healthcare is local and we’re excited by the reception from payers in Texas.
TOA: Do you think hospitals will continue employing independent physicians at a rapid rate in the Texas market?
Dave Rothenberg: Many health systems operate physician practices at a loss. For many, it is not their core competency. As we move to value-based pay, we may see health systems looking to reduce (or not increase) their employment levels and focus on being the high-quality, cost effective player in the market. But other hospitals fear loss of control, and see employing physicians as a way to better control the market. We expect some hospitals to slow down employment and others to keep pressing for it.
TOA: What happens if a family physician is locked into an EHR and other sunk costs that may prevent him or her from joining Privia?
Dave Rothenberg: Privia will not invite a physician to join the group unless it makes sense for them, financially. We have a very detailed financial pro-forma analysis that is required. Our focus is linking arms with the best independent doctors and together changing healthcare for the better.
Privia pays for EMR services and we transition doctors to it. We’ve integrated our population health tools into it and designed workflow so a physician does not need to do much more work to be successful in these new models. We’ve won national awards for revenue cycle management, and are among the top percentile performers among our EMR’s enterprise clients. It’s truly amazing how much better a practice can do when aligned with Privia. We provide the access to resources practices need to succeed, while granting doctors the autonomy they want.