"For most practices over the past several years, there's a downward trend in reimbursement relative to their services. Real estate is another good example as groups look to create and control other sources of revenue."
Many access points
Access is critical to executing this type of strategy, and means big investments in facilities and types of care that widen the practice's footprint, says Parikh.
To that end, access to the practice's physicians is available electronically, by phone, or through traditional visits. In addition to the traditional practice, Community Care is experimenting with walk-in clinics staffed by physician extenders for common ailments, for which all visits represent a pure cash transaction (Community Care also has a network of urgent care clinics, which do accept insurance). Care coordinators and "health coaches" help patients navigate the group practice's 30 office locations and ancillary services as well as assist in obtaining referrals and continuing care with medical professionals outside the practice.
"Care coordinators are the new type of glue we can use in healthcare to help patients become more engaged in their health status," Kleinbauer says.
Community Care looks to exploit opportunities. It noticed hospitals in the area were struggling with scheduling radiology services and hospitalist services. So it created a hospitalist program for local hospitals to use and now takes referrals for outpatient radiology services.
It developed its two urgent care centers for the same reason. "Our patients were using the emergency room a lot so we established an urgent visit center through one of our acquisitions, which was so successful we rolled another one out in our service areas," Kleinbauer says. The centers don't compete with the day practices, but rather, "become an extension of our offices," he says. "I'd like to say we had a grand plan, but we saw opportunities, and as they came along we implemented a response to a community need."
"We're living in exciting times," Parikh says of Community Care's entrepreneurial spirit. "You can wring your hands or seize the moment and move forward aggressively, knowing more people will be seeking care outside the ERs. Further, you can make sure people can access primary care without physically going. Those are areas that represent tremendous opportunities."
Community Care Physicians engages in a number of innovative efforts.