Our Take

How Covid-19 Will Impact Medical Groups

15 Minute Read

The medical group’s “we before me” moment

During Covid-19, physicians rapidly innovated on pre-Covid norms. In many cases, this meant uniting around medical group goals that previously received tepid support.

As we head into the next phase of Covid-19, medical group leaders will need to continue to unify the goals of their groups. To do so, leaders must define new norms for telehealth, align compensation to group performance, reward flexibility, and standardize APP deployment.

 

The pre-Covid-19 reality

The primary disruptive force reshaping the medical group landscape leading up to Covid-19 was physician aggregation. According to 2018 American Medical Association benchmarks, there were more employed physicians than independent practice owners for the first time. Additionally, the number of solo practices continued to fall, and the lion’s share of medical school graduates favored employment.

But unlocking the value of larger medical groups proved tricky, no matter the aggregator. While private equity firms, health plans, large physician groups, and health systems all tried, no one really achieved outsized improvement to quality, cost, patient experience, or physician engagement through a large-scale medical group.

Universally, groups faced the same challenge: threading the needle between individual physician autonomy and group goals.

To win talent, some groups promised more autonomy and hamstrung their care transformation ambition. Others set expectations around shared goals, but the looming threat of physician burnout plus compensation tied to individual productivity created barriers to change.

 

Our take

Not surprisingly, Covid-19 will accelerate physician consolidation. New groups may be willing to partner, and aggregators will be even pickier about talent. Still, we will largely see the existing affiliation strategy at a faster pace, not a wholly new direction in aggregation.

The most important opportunity for physician leaders is harnessing the tremendous innovation from physicians and care teams during Covid-19. The gravity of the crisis, combined with stay-at-home orders and reimbursement changes, brought physicians into alignment with medical group goals. They transformed care delivery in a matter of weeks.

Graphic: Clinician-led changes amid Covid-19, by impact and resistance

With patient volumes slowly returning, the risk of backsliding to old practice patterns is high. Individual autonomy and productivity may re-fracture groups into loose affiliations instead of continuing alignment to shared goals.

Driving new momentum toward cohesive medical groups requires four actions:

Define episodes of care that blend in-person and virtual visits. Telehealth is here to stay, but groups will naturally recede from the record highs when there were limits on in-person care. Securing volumes and patient loyalty in this new market for care requires a consistent and easy telehealth approach. Marshall physicians to set the group standard: what is in person, what is always virtual, and what fluctuates based on market conditions and patient preferences.

Pay physicians for group performance over individual productivity. Covid-19 shattered the illusion of control that productivity-based models previously offered individual physicians. This is a rare moment where leaders shouldn’t need to spend large amounts of political capital to rally physicians to redesign compensation. Design compensation for the realities of care in group practice— volumes based on a team approach, telehealth, and succeeding at group priorities such as access, total cost of care, and patient experience.

Set expectations for group flexibility. Large medical groups responded to Covid-19 by flexing talent and leveraging their larger footprint to offer patients more options for care. For example, groups designated Covid-19 and non-Covid-19 sites to the advantage of both patients and staff. That flexibility was always possible but hard to realize. While future Covid-19 surges may be a helpful starting place, set a new baseline for when physicians are expected to flex.

Deploy advanced practice providers (APPs) autonomously. Covid-19 demonstrated the utility of APPs and should spur groups to continue to invest in this high-value care team member. Standardize autonomous deployment across the physician enterprise.

 

Four actions

Physician executives should take four actions to maintain momentum for a cohesive, large-scale medical group:

  • Action

    Define episodes of care that blend in-person and virtual visits

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  • Action

    Pay physicians for group performance over individual productivity

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  • Action

    Set expectations for group flexibility

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  • Action

    Deploy APPs autonomously

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Parting thoughts

Now is the time to drive momentum toward a more cohesive medical group. Below are our recommendations for your next steps to make progress against the four suggested actions for physician executives.

Define episodes of care that blend in-person and virtual visits

  • What are the most popular episodes of care for your patient population?
  • What physicians and care team members are already interested in helping set the telehealth standard?
  • What changes to care team workflow would make it easier to consistently meet telehealth demand?

Pay physicians for group performance over individual productivity

  • What group goals are the most important to include in physician compensation?
  • Which physicians should be involved in redesigning compensation?
  • How will compensation changes be rolled out across the group?

Set expectations for group flexibility

  • What flexibilities does the group need for surges in Covid-19?
  • Where are places within a given specialty that increased flexibility would help with patient access and growth?
  • Where are places across specialties that would help with patient access and growth?

Deploy APPs autonomously

  • Where are APPs already in roles that should be standardized across the group?
  • How do training, recruiting, and performance management reinforce those roles?
  • Where do we have gaps in our workforce that we should hire APPs into?
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