PDA Executive Summary

Physicians Direct Access (PDA)
A NOT-FOR-PROFIT ENTITY

“PDA is an independent physicians’ association providing general information of practice parameters and issues in a post healthcare reform era, weekly blogs that cover timely topics and news, physician professional credentialing, screened-vetted products and ancillary services, inclusion and access options to managed care contracts via a messenger model opt-in/opt-out mechanism”

Physicians Direct Access, Inc. (PDA), is composed of independent practitioners and other clinicians all engaged in delivering healthcare services. The business aspect of managed care contracting and the necessity of professional credentialing is provided by a business unit. The business services are provided by a management services organization (MSO). The MSO is a for-profit business unit that respects the separation of Texas legislative rules denying the corporate practice of medicine. A broad view of the MSO portrays that the comprehensive healthcare ecosystem is a canopy over the IPA/MSO operations. TMG owns other services that represent the benefits and healthcare delivery markets.

It is unique that the MSO contract is a long-term arrangement with PDA with a material early-termination agreement. This creates value within the MSO as a business with a specific income guarantee plus substantial incentive opportunities. The MSO is evolving to a center for capitalization and investor equity. Investment funding of the MSO will also drive the pursuit of a viable strategic plan that includes reaching out to the independent physician culture and demographic. In summary, the beneficiary of a re-energized and resourced MSO includes a better future for independent practitioners.

The IPA has served Dallas-Fort Worth metro-area patients for over two decades. Membership is open to physicians, podiatrists, chiropractors, nurse practitioners, physician assistants, and other licensed clinicians. The provider group is also open through an MSO operated contracting track to “Designated Providers” composed of outpatient and inpatient facility and service providers plus individual counselors and therapists.

Current managed care contracts served by the IPA number forty plus. A Medicare advantage pilot program is also serviced by PDA. A branded national product based self-funded platform is the IPA’s developing avenue into clinical integration (CIO type technology), population management entwined with disease intervention, wellness programing, and transitional care centers. Development of the next generation of patient care delivery, a different CIO format, is being pursued both independently and in a collegial role with a national hospital system.

PDA membership is physically dispersed around four Dallas-Fort Worth Tenet (THC) facilities and in a suburban area that was once contiguous with a hospital managed by Tenet. The THC relationship is amicable and mutually focused with PDA at this time on building a proprietary CIO. THC is also constructing Accountable Care Organizations, and owned physician practices. Also, THC has a robust new entity, Conifer Health Solutions, which has diverse offerings including clinical integration, financial management, patient population health management, and revenue cycle management. PDA remains as an early example of hospital-physician organization trial and error exploration of how to best work for common good.

2015 ushers in a new strategy of transitioning the MSO into much more than a manager of doctor credentialing and messenger model discounted fee-for-service products. The market for IPA services has changed over the decades of PDA service. Physicians are currently much more reluctant to join more than one IPA’s. The lowered reimbursement of the major insurers now approaches Medicare levels of payment, so the IPA’s utility in achieving better rates is not a fact. Additionally, the process of moving from one IPA to another is complex and lined with bureaucratic pitfalls. Plus, as close to fifty percent of the physicians in Dallas are either acquired or engaged in concierge practices, the available pool of IPA candidates is drastically smaller. In total, an IPA is a necessary model for independent physicians but it is only currently viewed as a necessary utility with no pricing elasticity, i.e., the downside of a past business model that has not changed with the environment. Thus, 2015 will usher in new revenue development for independent physicians. The old ways are worthy, but new programs the solution for top-line practitioner practice growth.

There is a large opportunity for an organization that provides leadership, new revenues, sophisticated revenue capture, and a better way to clinical integration. The big hospital systems, insurers and the government have long struggled at great expense and slow progress to make such a group viable. It is clear to the MSO that it will take a new healthcare ecosystem to make such a group work at high quality and material throughput. And that is the next message to share.
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