New Marketplace
Clip
Room for Small, Independent Practices? (02:30)

There is plenty of room for small independent practices, says Harvard health policy expert and internist Michael McWilliams — and too much emphasis on downside risk. “I don’t know what that really gets us. It requires scale and some degree of consolidation,” he says. Evidence shows that the most effective payment model in terms of savings thus far is the Medicare Shared Savings Program, which is essentially devoid of downside risk. “With the right regulations in place, the right models, there is no reason why a smaller practice can’t be in a one-sided contract and make inroads.”

Griffin Myers, Chief Medical Officer for Oak Street Health, somewhat disagrees, pointing to the problem with romanticizing small independent practices. “[When] we say that medicine is so hard and it’s technical and it’s like rocket science, and it requires all this training, but then at the same time, I can do it and I can have a family member be my accountant and still do it — that doesn’t make sense to me,” he says. “It’s very hard to do something really well meaningfully, consistently, if it’s hard, and do it by yourself without a team.” Small practices don’t necessarily have the infrastructure or resources to measure “all of the things that we know matter.”

It depends on what we mean by small, adds McWilliams. The literature suggests that after a dozen or so physicians, practices have plenty of room for scale without hospital integration, as well as the capabilities for measurement and taking on risk.

From the NEJM Catalyst event Navigating Payment Reform for Providers, Payers, and Pharma, held at Harvard Business School, November 2, 2017.

More From New Marketplace
Hospital-based ACOs Key Capabilities Are Different Based on Level of Risk

Hospital-based ACOs Face Challenges in Tracking Performance Indicators

A focus on bundled payments for specific episodes of care — versus the broad changes required in an ACO model — may be a more effective method for ACO participants to develop capabilities required to measure utilization, cost, and revenue metrics.

Medicaid Referral to Specialist by the Numbers without eConsults

Can eConsults Save Medicaid?

How eConsults unlock medical expertise for the underserved.

Transparency Can Improve Both Quality and Cost of Care

Survey Snapshot: Seeing Progress in Transparency, but the Quest for Value Continues

NEJM Catalyst Insights Council members agree that despite the challenges and caveats, transparency efforts are essential.

Growth in alternative payment models shared savings shared risk bundled payments population-based payments

The State of the Evidence on Payment Reform

Despite some successes among the many efforts to execute value-oriented payment models, the lack of rigorous independent research studies impedes robust progress.

University of Utah Health Buzz Survey Report Cost of Care and Physician Responsibility Out-of-Pocket Costs

Buzz Survey Report: Cost of Care and Physician Responsibility

An independent NEJM Catalyst report sponsored by University of Utah Health on how practicing clinicians and health care leaders view health care costs.

Donald Berwick Melinda Buntin Patrick Conway Raymond Vara Edward Prewitt head shots IHI forum panel on health care policy

Signal or Noise? Navigating Health Care Policy — Part 2

A discussion from the Institute for Healthcare Improvement National Forum. Part 2 of a two-part series.

Transparency Initiatives Are Maturing But Have Far to Go

New Marketplace Survey: A Slow Path to Transparency for Patients

There is national momentum to empower patients with actionable health care information. But how well is the health care industry faring with this push to improve patient-facing transparency?

Donald Berwick Melinda Buntin Patrick Conway Raymond Vara Edward Prewitt head shots IHI forum panel on health care policy

Signal or Noise? Navigating Health Care Policy — Part 1

A discussion from the Institute for Healthcare Improvement National Forum. Part 1 of a two-part series.

Union Square Family Health Evolving Clinic Schedule - after integrated practice unit changes

Leveraging IPU Principles in Primary Care

How a safety-net clinic reorganized into multidisciplinary teams and restructured clinic flow to improve both efficiency and continuity of patient care.

Goals for Health Care Price Transparency and How to Measure Its Success

Defining the Goals of Health Care Price Transparency: Not Just Shopping Around

What policymakers, providers, and payers need to do to make price transparency successful.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Hospital-based ACOs Face Challenges in Tracking…

A focus on bundled payments for specific episodes of care — versus the broad changes…

Bundled Payments

51 Articles

Hospital-based ACOs Face Challenges in Tracking…

A focus on bundled payments for specific episodes of care — versus the broad changes…

Survey Snapshot: Seeing Progress in Transparency,…

NEJM Catalyst Insights Council members agree that despite the challenges and caveats, transparency efforts are…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now