PwC's Next in Health

The importance of physician enablement to our health ecosystem

• PwC's Health Research Institute • Season 3 • Episode 23

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Tune into this episode of PwC's Next in Health to hear Strategy& Principal, Igor Belokrinitsky, in discussion with PwC Strategy& Director, Rohit Nayak, PwC Strategy& Senior Manager, Sri Murthy Guru and PwC Strategy& Senior Associate, Cailin Hong, on what physicians are seeking from payers, health systems and management services organizations (MSOs), to help improve the practice of medicine. This episode includes:

  • Emerging business models and solutions that can enhance the physician experience
  • The role of payers and providers in driving physician enablement within the health ecosystem
  • Actions health organizations should consider to help support and encourage their physicians 

For more information, please visit us at: https://www.pwc.com/us/en/industries/health-industries/health-research-institute/next-in-health-podcast.html


For more information, please visit us at: https://www.pwc.com/us/en/industries/health-industries/health-research-institute/next-in-health-podcast.html.

Speaker 1:

Hello and welcome Tori's next in health podcast. I'm Igor Bella Kresky. My principal was PWC strategy end where I helped leading health organizations was their strategies and operating models. And I co-host. The podcast was Jenny coop Piero, who is vice chair for health industries, working for pharmaceuticals, MedTech payers, and providers. And today I am excited to welcome RO NAK, Kan, Hong, and Sri Morty to the podcast. All three of them are with strategy end and all three of them help health organizations drive their transformation to create greater value for all the stakeholders in our healthcare ecosystem. And today we have a very important topic because today Rohit Kalin, Andre will tell us how we all can help improve the practice of medicine for physicians. So welcome Rohit Kalin, Andre.

Speaker 2:

Thank you for having us it really to get the party started.

Speaker 1:

Excellent. Excellent. So over the past few months, we've had a number of conversations on this podcast about probably the most important and most difficult topic in healthcare, which is people we've talked about burnout among the physician and nurses. We've talked about shortages, and we're gonna get continue that conversation today. And the exciting part about today's conversation is the team that's with us here is not just gonna admire the problem and talk about all the challenges, but they're also gonna help us think about what are the things we can do to fix it and how various health organizations can make the practice of medicine better for physicians so that we can continue attracting and retaining great physicians that we need. We want to encourage physicians and we in particular will talk a lot today about independent physicians. And we do want to encourage independent physicians. They bring entrepreneurship, they bring innovations and they bring competition. And that creates great benefits for health consumers. So perhaps to start with row head KA Andre, you've been out there doing work and surveying physicians to understand how they feel and what their experience has been like. So tell us what's going on nationally in the physician environment.

Speaker 2:

Sure. Regor this is RO I can get us started on that. So overall, as you know, we're in a very interesting phase of healthcare where the healthcare consumers, which is members, employers, and regulators are really demanding and paying for services that are generating value and improve experience. And there is also a very common acknowledgement across the entire ecosystem that physicians, especially primary care, is it the center of the entire ecosystem, both in terms of managing outcomes and also reducing cost and what we are seeing, I think through our numerous interviews with physician and surveys, physicians are getting marginalized in the process and there's evidence to see that the burnout has been especially high with the administrative workload. That's been driving physicians to the ground spending three hours of pajama time every evening, and also the rising and complexity with all the alternative payment. And these other thing, which I think you'll lead to in your introduction is we are also seeing physicians lose their autonomy that is driving some dissatisfaction, a well known fact that new physicians running their workforce would rather prefer to be with, uh, organization versus open their own factors due to the complexity involved. So in summary, I think to kind of address the issue that we need to kind of solve for, we need to create an ecosystem that enables physicians to practice at top of their license and somehow return to their entire joyful bliss of practicing medicine. I really like the word joyful bliss ego issue with no, it's the term that came up in one of the interviews. And the was so excited to say that because that's how they are used to practicing medicine. And there are elements that make me feel positive. We are, I think, headed in the right direction. All the clients that we've been serving, this is the very common question that folks are still grappling with. And we are seeing big players and across the valley chain, they think health plan, health systems, even big box retailers and pharmacy that are investing a ton of money in kind of doing their bit for enabling physician then based on what their value proposition is. And also we are seeing a lot of venture money. That's flowing into the space much more than how it's been over the last few years. So in short, I think there's a lot of work to be done, but there is also things that headed in the right direction.

Speaker 1:

Thanks, Rohit. I love the term joyful bliss. And before we go much further, I wanna probe in another term that you use pajama time. Can you tell us a little bit about what that means? You mentioned physicians spending pajama time in the evening.

Speaker 2:

Sure thing. So in short, after physicians that do on seeing patients and delivering care and practicing medicine, they have to spend at least two to three hours recording what they saw, which is capturing notes, matching up codes to kind of the things that they have prescribed, et cetera. And this is important, especially for the payers so that they can get paid for the time they spent with patients. And that time is a lot like it's reducing over time. And there's a lot of technology that are being used to reduce that time, but still physicians spend a ton of time in the evening doing this administrative work.

Speaker 1:

Understood. Understood. Very interesting. And so Roe had you started talking about some money flowing into this space, the need to improve the practice and perhaps move a little bit closer to that joyful bliss. Can you talk a little bit about what are the existing solutions in the market today? What's out there to help improve the experience of practice for physicians?

Speaker 3:

Yeah. You, I could take this. This is Kaylin first. Thank you so much for having us here. It's really a pleasure to be able to hear some of our findings from our survey with you today. I think in terms of how players in the market are responding to this, typically enablement falls into three categories. First you'd have practice administration. So helping with things that kind of pajama time that RO was talking about it's budgeting revenue cycle management, how can you improve efficiency, economies of scale and improve collections and payments. Then there are things that are more around how do physicians manage this complexity around value based care. So things around risk, bringing organization operations value based contract negotiation, change management related to that. And, and there's this third category that's really about the practice of medicine, clinical care management. So things like clinical decision support, care navigation, and then thinking about how you integrate care in new sites, whether it's in person virtual or hybrid models. And so the players in this space, we've been receiving the front of this BC money. We've started to talk about, have taken on different roles. So bringing different permutations of these offerings and unique business models to serve this really large and diverse market of physician end users. So you'll see some of them offer end to end support for value-based contracting specifically the, a combination of contractual and clinical enablement. And then what then that some of them might focus on the business model by entering long term arrangements over the next 20 years as a joint venture. And others might focus specifically on a specific population. So like Medicare, but others might choose to focus on a more flexible model of end to end support. So they might think about how do you help a physician that's really just focused on fee for service and then provide some of that on alternative payment model support when the physician is ready and then you'll see others provide specific capabilities and even adapt their portfolio positioning over time. There's a number of organizations that started out as just doing revenue cycle management and intake and moved into clinical decision support. Others had moved from just doing data to more comprehensive value based care. But overall I'd say the key takeaways are that given the heterogeneity of physician needs, there's a broad range of business models and offerings that can serve market demand. But really the trend is towards greater automation to address physician burnout and enabling new care models that are primary care centered, value-based care, enabling that improve clinical outcomes will managing costs. And these are solutions that I've mentioned that are primarily serving physician end users. But I think what's exciting about this is how payers and providers have started to make it a priority. And that's to records point where you see money from different stakeholders starting to move into this space.

Speaker 1:

Very interesting. So is if I'm a physician, I have this kind of ordering array of offerings and services and apps and tools and platforms that you're describing that are emerging to meet my needs. And I have to figure out which one of them or combination of them I'm going to deploy. And then you also brought up payers and providers. And a lot of our listeners are affiliated with health insurance companies and health systems. And so what is their role that they have to play in this process? Because they obviously also want physician practice to be more rewarding and fulfilling and efficient and produce higher quality. So which should the prayers and providers know, and what should they do?

Speaker 4:

You got it, a street here and I can, I can take this question. So like killing, there are a variety of payers and providers as well, and they're making some big investments. As we have seen with some of our clients, ultimately, whether it's payers or providers, they're all driving towards a few common outcomes, whether it is better quality of care, whether it is lower costs for patients and members while driving excellent outcomes when it comes to healthcare or whether it's enhancing the patient or member experience across the various touch points, whether it's when they're accessing care or consuming care or paying for care, that's really what pays growers really care about. However, specifically, payers care about this because enabling physicians with the right data with the right technologies and tools helps deserve independence, which I think you do at the beginning of the podcast creation of these independent physicians and supporting them with the right tools and technologies to create competitive networks, high performing networks that will benefit the entire ecosystem. And similarly, on other side providers meaning large health systems, they would really care about this because it minimizes staffing shortages, which we have seen has become a problem or time, particularly since COVID. It also helps these large providers build higher performing networks that enhances the value proposition in front of payers and improves interoperability and integration with the rest of the providers network. And actually it's a great way to have independent high quality positions in the providers network without necessary really paying through the roof to acquire them

Speaker 1:

Very interesting, lots of compelling reasons to care and to help. And so if a health organization is interested in playing a role in this and encouraging and supporting physicians, how does it get started given all these different options that are out there?

Speaker 2:

So also before even at get started with the response, I think the term health organization has expanded, I would say over the last few years, initially it used to be this slow ecosystem of providers who used to interact with can be client systems, et cetera. Now, I think we have all kinds of clients asking this question and it's the entire ecosystem starting from, of course, health plans, health pro writers to big box retailers, to digital health companies, to even financial services companies, which didn't really have that much to do with this space. So having said that, I think the jury's still out, what's gonna work versus not, but we are seeing certain successes in this space. And the success story is basically have two things in common. Number one, I think there's definitely a deliberate phased approach instead of going all in leveraging the right partner, then having that mindset that you can't do all of this by yourself. So you have to find the right partners to partner an area, which is not your core and then most important, which I think it's a cliche, but also to say that healthcare is local. So you need to customize your solutions to not just the local membership, but also to the local physician group to manage the complexities in the local region. So having said that there are three elements that broader any health organization would do think about to get started on this. Right. Number one is define what the value proposition is that you bring to the table. And that value proposition should definitely be very closely aligned to what your current market offering is and how your position to the market. And this will kind of help clarify the problem you're solving. And as an example, we've seen health plans double down on kind of reducing the admin complex cities are helping with physicians on core practice administration, right? It's not as the fancy predictive analytics to predict care outcomes, which they do, but this is a very run solution, but it does help physician improve their collections, get more time to spend with their members and patients. Second piece is now that they've defined the value pro is what are the capabilities that'll help you enable the value proposition and, you know, Kalin talked about what the broad spectrum of capability is. The important piece is to pick and choose capabilities that you really wanna kind of double down on which you wanna build. And then also thinking about capabilities that you likely source in another partner or it even by, and lastly, I think, which is important because for any company to survive, you need to have a sustainable financial and a business model. So what's the right business model that you want to pursue. And we've seen that across multiple areas. For example, you can have a business model that pays this for the service you deliver all the way to, of taking both upside and downside risk. So I would say this would help you get started, but I think you should just getting into the space. You should know that it's a new space, has a lot of value to be uncovered, but it's also a lot of work that needs to be kind of put in and very different from how we approach this problem before. And our prior experience, we have helped a broad area of clients are having interviewed about 50 to hundred physicians and surveyed more than thousand physicians. We have some really cool insights that we can share.

Speaker 1:

I think it would be a great place to conclude this is to let the physicians have the last word. And so, yeah. Would love to hear what kinds of things you saw in the surveys in the interviews, what are physic saying?

Speaker 3:

So something that was really shocking in our surveys is the extent to which physicians don't necessarily trust these organizing GPO type entities that are labeled and identified as MSOs IPAs, the folks who do ultimately wanna help them. A lot of the responses we heard were they're tired of middle men taking a cut and distracting from them being able to practice medicine, which I think is a valid concern. We'd also heard that 80% of our survey physicians believed that they were not part of an IPA, which we know from broader statistics, likely not the case. So I think overall, this suggests that there's an opportunity for more thoughtful branding that better articulates the value these organizations are trying to make and maybe move away from some of these labels and really communicate how the capabilities being offered can make your life a little bit easier by decreasing the amount of time you're trying to of focus on like coding and capture or negotiating with the payers and help enablement players improve their positioning, but making clear what the reduction to physician admin burdens is and how ultimately they're working to help physicians to improve their financial upside instead of taking on that middleman kind of label.

Speaker 4:

And I'll just add onto what Kate and just said, yes, physicians really care about a lot of the traditional areas that are under loops, meaning revenue cycle management has been an issue for several years, and it's still a lot of opportunity there. When we ask physicians, what are some of their highest needs? Not only did physicians talk about new and emerging areas like, Hey, we interested in better it and cyber security. We are interested in virtual care, EMR integration, but also a lot of their needs were very basic. Meaning how can we get accurate billing and coding and financial management, which seems to be the case for several years now. And I think there's an opportunity for the enablers who are, are stepping into this space to actually focus first on the foundational needs, as well as think about emerging new needs.

Speaker 1:

These are fantastic insights and really helpful for anyone who's looking to build trust with physicians, understand them better and improve their experience of practice and make it more fulfilling. So Kalin, Roe, a tree, thanks so much for joining us and sharing your insights. We're hoping for last pajama time for physicians and more joyful bliss of practice. So thanks for being here.

Speaker 3:

Yeah. Thank you for having us.

Speaker 2:

Thank you so much for having us through the pleasure talking about this topic. And as you know, we can talk a few more hours about this

Speaker 4:

Zibo. We enjoyed the discussion today

Speaker 1:

For more on these topics and other health industry insights, driven by policy innovation and care delivery changes. Please visit our website@pwc.com slash H R I until next time, this has been next in health.

Speaker 5:

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