3 strategies for launching innovation in independent practices

The “dazzle factor” in healthcare shines bright, from the ability to use artificial intelligence to read X-rays to technologies that can detect cancer from a drop of blood. But for independent practices, navigating the roadblocks that often exist when shifting to a value-based care model raise an important question about innovation: “What good are great ideas in healthcare if we never try them?”

Community physicians are uniquely positioned to generate ideas that make a difference for the populations they serve. They see the impact that social determinants of health, such as lack of transportation, food insecurity, and poor quality of housing, have on a patient’s ability to manage chronic disease, and they are intimately familiar with the behaviors that deteriorate health.

But while there is no lack of discussion on the need to innovate in healthcare, independent physician practices lack the resources of private-equity funding or health system dollars, infrastructure, and manpower to bring great ideas to life. They also struggle to find the capacity to innovate: 80 percent of physicians say they are at full capacity or overextended.

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Yet independent practices also hold a significant advantage over hospital-owned practices in driving innovation: lack of red tape. 

How can independent physician practices provide the right environment for creative discussion and drive action around the best ideas their physicians present? The experience of Holston Medical Group, an independent physician group serving 350,000 patients in the Appalachian region, points to three strategies.

Devote time for innovation discussions. Our physicians act upon the creative ideas their peers present without having to undergo layer upon layer of approval-and it’s a game-changer for our practice. Providing regular time for brainstorming is key. At Holston Medical Group, we held lunchroom innovation sessions to fuel creative thinking among peers around how to address some of the biggest challenges our patients face. The ability to sit together and bounce ideas off one another excites physicians, and it holds strong appeal for the physicians we recruit as well.

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Some of the physician-led innovations we’ve introduced include:

• A nationally recognized clinical research department that empowers our practice to provide emerging treatment options for our sickest patients

• An extensivist clinic-staffed by hospitalists and nurses with intensive care training-that helps patients with complex care needs avoid a trip to the emergency department (ED) and potential inpatient stay 

• A partnership with Mayo Clinic and the National Institutes of Health that enables Holston Medical Group physicians to help test ways to apply precision medicine in clinical settings, such as the use of pharmacogenetics to determine the most effective drug treatment for a patient based on the individual’s DNA

Focus on people and processes. Not all advancements in healthcare delivery are technology-based. Innovation also comes from examining care delivery processes with a patient-centric lens and seeking ways to improve the care experience and health outcomes. For example, how could your practice alleviate total pain and suffering in patients with chronic and total disease? What measures does your practice undertake to ensure care for senior patients takes into account not just their health status, but also their quality-of-life goals?

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At Holston Medical Group, our physicians recognized a need for specialized care for seniors aging into Medicare through the end of life. These services often are not available in lower-income and rural communities like those we serve. We created HMG Alternative Outreach Services, a medical facility uniquely designed to treat the needs of geriatric patients, including those who live in long-term care facilities. Supported by two nurse practitioners and the region’s only board-certified geriatrician in hospice and palliative care services, this initiative helps ensure geriatric patients and their spouses are treated with dignity and respect. It’s an example of the impact independent practices can make when they seek to solve complex care delivery challenges and invest their efforts towards caring for this high-risk population in unique ways.

Look for opportunities to innovate in partnership with other practices. For example, patients who have cancer see specialists outside of our multispecialty practice. The ability to access these specialists’ notes when these patients come to us with ailments seemingly unrelated to their disease empowers our physicians to look for connections between their oncology treatment and the new health issues they face. It’s one reason why Holston Medical Group invested in OnePartner, a cloud-based community health information exchange (HIE) and promoted its use among providers across the region. 

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Today, more than 95 percent of care encounters from 1,200 participating physicians in our region are captured within OnePartner-a tool that allows for more informed discussions among physicians and higher-quality, highly coordinated care. It has also spurred the development of programs that meet the needs of vulnerable populations, such as:

• A care coordination team that connects high-risk patients with community resources such as Meals on Wheels, medication assistance, and transportation services

• An annual wellness visit nursing team that assesses Medicare patients’ emotional and psychological well-being and helps ensure patients with behavioral health needs receive the appropriate support

• A care transition team that helps eliminate gaps in care after hospital discharge, when patients leave an environment where they are heavily monitored only to risk not being monitored at all 

Initiatives such as these have significantly reduced readmissions for Holston Medical Group (with decreases ranging from 6.8 percent to 12.3 percent, depending on the payer), achieved an ED utilization rate that is 25 percent lower than other providers in the market, and boosted value-based payments from $200,000 per year in 2010 to more than $13 million in 2018.