Thursday, June 12, 2014

Full steam ahead at Partners

For those of you in Massachusetts who still think that the deal between the AG and Partners Healthcare System will restrain the growth in this system's market power, check out excerpts from this current job posting from ZurickDavis, a health care executive search firm.  It sure doesn't look like PHS is feeling very constrained about network growth.

Partners Community Healthcare, Inc. (PCHI) is seeking a Vice President of Network Development (VP). The President and the Board of PCHI have created this senior position to lead the newly refined mission of PCHI, now the community physician enterprise of Partners Healthcare. The Vice President will work with the senior leadership across the Partners system to implement the community physician practice strategy, enhance the network, and further develop PCHI infrastructure to support alignment and coordination across the system. The new VP of Network Development will join PCHI at a uniquely opportune time.

PCHI is a founding member of Partners Healthcare, which was established in 1994 by two world renowned hospitals, the Massachusetts General Hospital and Brigham and Women’s Hospital. Partners Healthcare grew quickly and broadly in its first 20 years and PCHI was a key player in that growth and evolution.  PCHI has a $200M budget and has produced positive operating margins. The PCHI network has 600 PCP’s, 1,400 specialists, and includes 650,000 covered lives. 

The Vice President of Network Development reports to the PCHI President and is the leader who will drive the value proposition and make the case for joining the PCHI network. The VP will evaluate the markets and the opportunities for network expansion of the PCHI community physician enterprise. The Vice President will develop innovative business models and create incentives for community practices to join PCHI.

The new VP of Network Development will be a highly visible leader in PCHI and Partners Healthcare. S/he will collaborate with network development leaders at MGH, BWH, and the other Partners organizations. The VP will be at the helm of PCHI network expansion as the PCHI mission is being recast as Partners Community Physician Organization, the network of choice to attract and retain the best community practices and physicians.

The right candidate will be a recognized leader in the health care marketplace, a network builder, and a strategist with excellent relationships with physician leaders. A dynamic and innovative leader, he or she will have substantial experience in business planning and negotiating physician group network and business agreements.

Gene Lindsey's prediction seems supported by this recruitment:

While the AG’s office is monitoring price and preventing the acquisition of other hospitals or large medical groups, what will be really happening? What will be happening is that money will be flowing from the vast resources that already exist within Partners from their previous price and contract advantages to build and populate ambulatory care centers and practices in the communities of these new acquisitions. The paper talks about an additional 550 physicians. That is more than enough to take care of more than an additional 500,000 patients. Take the South Shore as an example. It is rumored that a new magnificent ambulatory facility will be built for 80 new PCPs. That would translate into at least 180,000 patients, if not more. The South Shore is growing but the population of the 16 towns that constitute its whole area from Quincy to Plymouth is less than 500,000. 

So where will the patients come from that will fill these new offices? My guess is that the patients will come from the existing practices of physicians on the South Shore. The deal prevents them from joining Partners as a group but it does not prevent them from individually relocating their employment and having their practices follow them. The future of finance in healthcare is not your price; it is the population that you serve. It will be very hard for existing practices on the South Shore to compete with the resources that will flow into the South Shore from Partners. About the time this transition is completed the prohibition on price increase will expire. By that time there will be little or no residual competition to balance the market. A five to ten year deal in healthcare is no deal at all.


Bob said...

Break up Partners! Are they a cable company or a utility? No. Let them prove that their size improves care and cost for the populace - the burden of proof should be on them.

Brianne said...

Alan Sager from BUSPH predicted this in 1993...a healthcare monopoly.

Brianne said...

Alan Sager from Boston University School of Public Health called this downsizing of health care to a mega monolith in 1993

Anonymous said...

There are so many aspects of this deal that are tailored to sound reassuring but are, in fact, hollow. Before any real information was available to understand how or if this approach could actually work, the Boston Globe was very eager to believe that a secret handshake between Partners and the Attorney General's Office would undo the damage caused by The Secret Handshake between Partners and Blue Cross that the Globe's own news division uncovered in 2009. It astonished me that without any information on how these "caps" would be enforced or monitored the Globe expressed such strong, unconditional support. How could they tell this deal would have the intended impact? For example, will this deal rely on the same insurers who kept silent for more than a decade (while doling out 10-15% annual price increases to Partners) to throw a flag on the field if they believe the cap is eclipsed? Or will there be a monitor keeping up with all of their contracts and systematically quantifying price increases/decreases in real time to ensure compliance? Will the increases be estimated projections or will actual total price increases be calculated as a look-back and adjustments made on actual service types and mixes? And the very simple physician market share math that Gene Lindsey laid out is of no concern even IF the caps can be enforced? I'm afraid these admittedly tedious details matter quite a bit; an "estimated" 1.5% increase can easily become double or triple that as norms of care change and the clever people at Partners carefully select which services they decrease prices on by 5-6 % and which they increase prices on by 6 or 7 percent. And if Partners can add a number of physicians that effectively would give them all of the remaining unaffiliated physicians in Eastern Massachusetts, is that really a growth cap at all? The Globe blessed the deal (without reservation or caution!) in the absence of the answers to these reasonable questions and concerns; puzzling indeed.

I appreciate that your blog is a place where we can get a more realistic analysis of this situation rather than the blindly rosy acceptance of a story that hopes to put to rest an inconvenient political hot-potato. Ignoring the fact patterns of the past 20 years, and chalking up concerns with this deal as the wonky white noise of the sour grapes crowd, will not lead to an outcome the Commonwealth will be proud of in another 20 years. I continue to wonder what harm could possibly come of a transparent, thorough, fact-driven analysis of such an important settlement?

The future Gene Lindsey paints is all too possible and of national importance as other states look to Massachusetts to see what we will do to reign in costs. At least your blog will be one place where our national counterparts will see it was debated in the clear-eyed, analytical way it deserves. However it is a huge loss if, for the most part, our elected officials, local media, and public institutions choose not to insist upon and participate in a transparent and rigorously analytical process.