{"id":608,"date":"2019-04-12T08:27:35","date_gmt":"2019-04-12T12:27:35","guid":{"rendered":"https:\/\/digital.hbs.edu\/platform-mhcdsolutions\/submission\/developing-a-strategy-for-womens-health-ambulatory-practices-while-facing-the-threat-of-a-private-equity-company\/"},"modified":"2019-04-12T08:27:35","modified_gmt":"2019-04-12T12:27:35","slug":"developing-a-strategy-for-womens-health-ambulatory-practices-while-facing-the-threat-of-a-private-equity-company","status":"publish","type":"hck-submission","link":"https:\/\/d3.harvard.edu\/platform-mhcdsolutions\/submission\/developing-a-strategy-for-womens-health-ambulatory-practices-while-facing-the-threat-of-a-private-equity-company\/","title":{"rendered":"Developing a Strategy for Women’s Health Ambulatory Practices while facing the Threat of a Private Equity Company"},"content":{"rendered":"

Background:<\/u> <\/strong>Recently I have become the clinical lead of 8 existing employed women\u2019s health practices under a broader medical group as part of my health system.\u00a0 These practices include both general women\u2019s health care and subspecialty care (e.g. urogynecology, minimally invasive surgery, etc).\u00a0 The challenges of this role have piqued due to planned acquisitions of 3 private practices and negotiations are ongoing with several other private single providers.\u00a0 The acquisition of these practices is integral to retain the patient base that is served by our hospital.\u00a0 This spate of activity is the direct result of the challenges of private practice, an aging workforce and the recent threat of a large private equity corporation seeking to purchase private practices.\u00a0 The financial interest of the private equity corporation is to obtain scale, negotiate with insurers and take the profitable outpatient surgicenter\/lab\/imaging referrals to an owned consortium. Currently this private equity company is negotiating with the two largest provider groups that represent 39% of deliveries and 37% of surgical care. Some independent providers remain. \u00a0\u00a0Finally, we will complete an 8 story maternity tower in 2020.\u00a0 Though our only regional competition is a small independent hospital that delivers a 10th<\/sup> of the number of babies that our system does, we recognize that to support this facility in an era of declining births, we need to provide access to women\u2019s healthcare in what have traditionally been secondary markets.<\/p>\n

The currently owned practices are diverse in both what they do and the populations serve.\u00a0\u00a0 Philosophically the medical group system is committed to serving all of our neighbors. \u00a0Prior oversight of the employed practices has largely consisted of managing Joint Commission regulations and human resource management of staff. Medical leadership has largely been absent and operational philosophy\/efficiency and monitoring of financial performance has been ignored.\u00a0 In contrast, the integrating private practices are largely marked by strong clinical leaders, whose salaries were contingent upon maximal efficiency and were based on a volume model of care.\u00a0\u00a0 Compounding the issue is negotiating models of care that are built on outcomes and not volume beginning with shared savings programs and bundles of care.<\/p>\n

Statement of Questions:<\/u> To address these complex circumstances the following questions emerge about what our ambulatory strategy should be:<\/p>\n