The 12 Rules of Othercare

Obamacare was enacted on?March 23, 2010. Every year since, pundits predict the demise or significant alteration of Obamacare. The alternative to Obamacare is Othercare. In other words,?employed and independent practitioners can struggle using old models of care and try to chase their tail every time the government and payers issue new rules, or you can be innovative and proactive. Skate with the puck v skating to where the puck will be. You need to adapt to several major trends like fee for service migrating to payment for valued care, improving the patient experience, the demand for care outstripping supply, using technology to achieve the sextuple aims and many more. It's time for doctors to take care of business since, if they don't, they will no longer be able to take care of patients.

Retail medicine wants to put you out of the primary care business.

?The pace of change is getting faster. Every facet of practice is impacted. Saving private practice has become more challenging. The primary elements of change will be:

1) achieving the sextuple aim

2) care coordination

3) chronic disease management

4) data analytics

5). social determinates of health

6) technology

7) regulatory, reimbursement and rules changes particularly value based care

8) reforming medical education

9) transforming sick care to healthcare

10) low value to high value care

So what?are?health industry executives prioritizing in 2022?

1. Digital transformation

2. Hiring and retaining talent

3. New products and services in response to changing consumer behavior

4. ?Supply chain resilience

5. Corporate M&A or joint ventures

What do patients want?

1. Convenience

2. Costs to go down

3. Care coordination

4. Chronic disease management

5. Caring HCPs

6. Confidence that they are the primary interest

7, Confidentiality

8. Communication using words they can understand

9. Collaboration with family members

10. Community of people with similar issues

To thrive, practitioners, particularly those in primary care, must practice the 12 rules of Othercare:

1. Practice state of the art medicine migrating from a technician to a manager to an entrepreneur creating and transferring value to patients and payers. Entrepreneurs create value, not just companies.

2. Consolidate to garner market power. The trend toward consolidation of physician practices in recent decades is accelerating,

In the last few decades, the proportion of physicians in larger groups has grown. Several factors have contributed to this move from smaller groups, the authors note. Larger practices offer more administrative support, which can help with adoption and meaningful use of electronic health records as a driver of Medicare incentive payments; they also facilitate physicians' participation in population-based healthcare incentive programs, and in general, younger physicians, who represent an increasing proportion of the physician workforce, tend to prefer working in larger practices.

Independent medical practices are now increasingly looking to private equity to grow and compete in response to these market forces. And private equity is responding, fueling health care consolidation with billions of dollars. A study published in the Journal of the American Medical Association found that the number of?private equity deals with physician practices?across specialties more than doubled between 2013 and 2016. According to EY,?$32.9 billion in private equity?was invested in 647 health care transactions in 2018 — that’s double the investments made in 2014.

2022 was the second-biggest year on record for healthcare private equity by many measures, even though overall activity declined sharply from 2021’s record-breaking highs.

3. Use innovative care delivery models incorporating validated digital health technologies. Here are the 7 technology trends that are changing medicine.

4. Improve patient communication portals to improve the patient IQ , the exam room experience and after visit satisfaction.

5. Dominate on convenience, service and experience, not quality. Measure different value factors. Walgreens launched a new business segment, Walgreens Health, that ramps up the company’s capabilities in primary care, post-acute care and home care. As part of that strategy, the healthcare giant is?investing $5.2 billion in VillageMD?to build out more clinics and $330 million in CareCentrix.

6. Measure everything. Work more on your practice and less in your practice. Your office should be an idea lab.?Here is how to listen to your patients.?Your next innovation opportunity is sitting in front of you. Measure, measure, measure. Do you have a data-driven culture? How would Alibaba run your practice? What's on your CEO dashboard?

7. Adopt an entrepreneurial mindset?and implement individual and organizational tactics to identify, treat and prevent burnout.

8. Maximize practice management efficiencies and efficacies, particularly revenue cycle management and how new payment regulations affect your ability to collect what you have earned e.g. MACRA.

9. Be a leaderpreneur.

10. Fail early, cheaply, and often with new product line offerings. But, be careful not to step over the line.

11. Use a different business model. Although only a fraction of primary care doctors practice this way, the proportion has grown from 2 percent to 3 percent in the past year, according to data from the American Academy of Family Physicians, which supports this type of practice. Here are several other examples of patient driven business models. The latest threats in town are hospital to home, virtual care, retail medicine, DIY medicine, artificial intelligence, workforce shortages, private equity, the aging population, and changes in how and where we work.

12. Create a side gig that earns extra money where you can flex your physician entrepreneurial muscles.

?There are 2 major forces that have driven US sick care since the beginning of the 20th Century. One is legislative and regulatory. The others are the non-regulatory forces-demographics, technology, socioeconomics-that have an even greater influence on the future of medicine and how doctors should and will practice it.

To prepare future doctors to do these things, we need to create entrepreneurial medical schools.

Physicians and medical groups need to conduct a serious self-assessment to set realistic goals and determine their capacity to reach them. This will guide their decision on which of these eight options they should choose.

For too long, physicians have watched from the sidelines while government, the biomedical complex and private payers call the tune. It's time to get back in the game. Small medicine is under siege.

If you do not learn the business of medicine, you have no business practicing medicine.

Arlen Meyers, MD, MBA is President and CEO of the Society of Physician Entrepreneurs on Substack and Editor of Digital Health Entrepreneurship