For the past three or so months, an Arlington, Va.-based medical group has been quietly marching across Dallas-Fort Worth, seeking independent physician practices with whom to partner. Privia Health has attracted 65 practices and is looking for others in Dallas, Tarrant, Denton, and Collin counties. It’s already created a provider base of more than 200 physicians, nurse practitioners, and physician assistants.
It’s done the same near D.C.—where it began in 2007—quickly growing its network to more than 1,000 providers spanning across the Mid-Atlantic region: D.C., Maryland, and Virginia. It’s extended into the Texas Gulf Coast through a base in Houston (100 providers), into Georgia by partnerships in Atlanta (130), and now, most recently, North Texas. It is a population health services company, but also a medical group. Its officials say it helps shift independent doctors into contracts that incentivize value instead of volume, and requires buy-in from the partnering physician practice in the form of its tax ID code. It also must use Privia’s electronic health record system, so that the company’s data analysts can monitor their patients.
It launched alongside a well-regarded practice in each market, which it says helps to ingratiate it with potential partners. As its founder and CEO Jeff Butler told me, “It would be a lot of hubris for us to drop into a market and go out and start building something without a partner.”
Its teammate here is Larry Tatum and his Fort Worth-based Texas Health Care, a group of more than 150 physicians that had previously contracted Privia for services related to data analysis for its Medicare Advantage contracts. That history, Tatum said, helped ease the transition into Privia. Tatum, and any other practice that chooses to join, gets to run their business how they want to. They can hire and fire without approval from Privia, take vacations when they want. But the back-end services get handled out of house, as does the contracting. The goal is to eliminate fee for service, and have the support to do so.
“We’re looking for folks that want to be part of the group to keep the independence of their office relationship and be deadly serious of how you move to a value-based world,” Tatum says. “Our doctors have always been the ‘owner operators’ of their own practice sites: Where they practice, who they practice with, how big their space is, what they do for a living, what hospital they go to, how they staff their office. … The Privia model is exactly the same. This isn’t Big Brother showing up with a list of what the corporation says to do.”
The arrival of Privia dovetails with the ongoing consolidation in American healthcare and the need to build a broad geography to control the health of a population as they navigate the system. Contrary to popular belief, most physicians still care for patients in a small practice. According to an American Medical Association report released last year, 60.7 percent of physicians as of 2014 were in a practice with 10 or fewer doctors. And 56.8 percent of doctors worked in a practice owned by doctors, not hospitals. Just 32.8 percent were employed by a system.
As Medicare begins mandating that physicians take on more risk than before, concern sets in about those small practices. Will solo practitioners have the population and the infrastructure to track data and make sure their diabetic patients are adhering to diet and taking their medicine? Some are turning to hospital systems and becoming employed. But others would like to retain their independence.
“We need an ability to not have physicians all become employees of big monopolistic health systems,” Butler, the CEO, says. “Medicare is not reversing its course on this move to value. The doctors have said, ‘I’ve got to join something,’ so your choice is either become an employee of the hospital or maybe join a big fee for service group that’s trying to jam more costs in the system. Or, they can join a group like Privia, that’s really oriented and founded with a DNA around improving outcomes and taking costs out of the system.”
Privia isn’t alone in North Texas. Independents have the choice of joining a number of accountable care organizations, which don’t require their tax IDs. To note a few: Catalyst Health, headed by the outspoken independent and entrepreneurial primary care physician Dr. Christopher Crow, is making waves in Collin County and expanding into other regions of North Texas. Dr. Jim Walton, the former Dallas County Medical Society president, is the head of the Genesis Accountable Physicians Network. Baylor Scott & White Health has its own ACO in the Baylor Scott & White Quality Alliance, which accepts independent physicians. UT Southwestern Medical Center does as well, and Texas Health Resources is also exploring similar pathways. Even the Texas Medical Association has a physician services arrangement for independents.
Which is to say: there are options for the indies in North Texas. Tom Banning, the CEO of the Texas Academy of Family Physicians, notes the differences between all these choices. And he says that’s a good problem to have—independent doctors have resources here that can help them gather the infrastructure to adapt to the new payment models. But the question for Privia, Banning says, is whether the existing relationships are so entrenched that handing over the tax IDs will be a barrier.
“I think the challenge with the Dallas market is, how fertile a ground is left for those independent unaligned doctors?” Bannging says. “Most of the market that I’m aware of has already picked sides. And I don’t want this to sound bad, but perhaps some of those unaligned physicians that are left may not want in your group. There may be a reason why they’re still unaligned.”
Privia, however, believes it offers something unique and unmet in the marketplace. And they’re welcoming additional resources for independents.
“This requires massive amounts of capital, massive amounts of people,” says Dave Rothenberg, the president of Privia. “It’s not stuff you can do in a cottage way. And so I think an advantage we have is the size and the breadth. And, again, we’ve been doing it for a while. We have lots of proof points, but I’m rooting for folks like us to succeed, that’s for sure.”