{"id":114,"date":"2017-04-24T18:21:35","date_gmt":"2017-04-24T22:21:35","guid":{"rendered":"https:\/\/digital.hbs.edu\/platform-mhcdsolutions\/submission\/primary-care-growth-strategy\/"},"modified":"2017-04-24T18:21:35","modified_gmt":"2017-04-24T22:21:35","slug":"primary-care-growth-strategy","status":"publish","type":"hck-submission","link":"https:\/\/d3.harvard.edu\/platform-mhcdsolutions\/submission\/primary-care-growth-strategy\/","title":{"rendered":"Primary Care Growth Strategy"},"content":{"rendered":"<p><strong>The Problem:<\/strong><\/p>\n<p>In order to be ahead of the ACA, we need to grow our primary care base.\u00a0 Currently we have 5% of the Northern California market share for Primary Care.\u00a0 In the last four years, we have lost 5% to a combination of attrition to competition and change in work\/life balance of providers going the hospitalist route.\u00a0 We have been unsuccessful in recruiting <em>de novo<\/em> providers and have a defensive IPA that is precluding us from an acquisition strategy.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Market Snapshot:<\/strong><\/p>\n<p>Three major players in our area; two HMOs and us, a medical foundation.\u00a0 All are employment models.\u00a0 Competitors A and B contain roughly 50% of the primary care market share.\u00a0 We have roughly 5% and the residual 45% is independent.\u00a0 Our current medical foundation make-up is 90% Specialty and 10% Primary Care.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Supporting Information:\u00a0<\/strong><\/p>\n<ul>\n<li>Nationwide PCP deficit. Literature supports a primary care deficit for the State of California to be somewhere near 5,000 providers.<\/li>\n<li><em>De Novo<\/em> growth. Our competition has responded with $150,000-$250,000 sign-on bonuses or loan forgiveness programs amortized over 5 to 7-years. We are unable to come up with a financial model to respond.\u00a0 Furthermore, even with these large outlays, our competition has been unsuccessful in recruiting primary care to service our communities.<\/li>\n<li>Acquisition strategy. In our Northern California markets there are 45% independent PCPs that are or will be looking for employment.\u00a0 We have had several of these independent\u00a0groups express interest in becoming employed by us, however, the largest IPA in the area is precluding an acquisition strategy by preventing a rather large discretionary bonus to any physician that joins our medical foundation.\u00a0 These amounts vary between providers but range on average from $100,000-$250,000 for quality and risk-adjusted factors.\u00a0 \u00a0Therefore, when approaching these groups, none are willing to risk the bonus (a considerable part of their compensation). This has prevented any successful acquisition.\u00a0 The IPA has almost 80% market penetration and is the predominant IPA in the area.\u00a0 Furthermore, I have been unable to negotiate with the IPA. \u00a0 The relationship is further complicated by just how significant the IPA is to us.\u00a0 They represent nearly 20% of our book of business for both primary care and specialties. We believe this is a defense strategy for if we acquired enough primary care providers, our belief is that they would see us as a direct competitor that could potentially start our own IPA.<\/li>\n<li>Allied Health (PA and NP) remains sticky at best. Several of our payers including the IPA above, restricts allied health professionals into an \u201cincident to\u201d billing model thereby restricting new patients from access to allied health professionals.<\/li>\n<li>We have a family medicine residency program through our largest hospital which on average produces 10 residents a year. In the last three years, only one resident has remained in the community (she went to one of the independent provider groups).<\/li>\n<\/ul>\n<p>I am looking for outside the box ideas or strategies on how to attract primary care providers to our markets. \u00a0Given the above, perhaps a model of a shorter work week may be a competitive advantage for us. \u00a0Currently, all primary care providers work 5-day work weeks without call obligations.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>In order to be ahead of the ACA, we need to grow our primary care base.<\/p>\n","protected":false},"author":9184,"featured_media":116,"comment_status":"open","ping_status":"closed","template":"","categories":[23,22,26,24,25],"class_list":["post-114","hck-submission","type-hck-submission","status-publish","has-post-thumbnail","hentry","category-aca","category-access","category-growth","category-primary-care","category-strategy"],"connected_submission_link":"https:\/\/d3.harvard.edu\/platform-mhcdsolutions\/conversation\/mhcd-solutions-ii\/","yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.3 - 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