Q&A: Privia Health’s Keith Fernandez, M.D., on Fostering Physician Leadership

Physician enablement company Privia Health (Nasdaq: PRVA) saw its 10 ACOs achieved aggregate shared savings of $176.6 million in 2023 through the Medicare Shared Savings Program (MSSP), a 34.1% increase from 2022. Nationwide, the Arlington, Va.-based company works with more than 4,500 providers on practice improvement and value-based care. Keith Fernandez, M.D., the company’s chief clinical officer, recently spoke with Healthcare Innovation about what’s behind Privia’s growth. 


Over the last seven years, Fernandez has led Arlington, Va.-based Privia’s Gulf Coast market’s participation in the MSSP. Prior to joining Privia, he served as president and physician-in-chief of the Memorial Hermann Physician Network (MHMD), chief medical officer of the Memorial Hermann Accountable Care Organization, and chairman of MHMD’s Clinical Programs Committee.

Healthcare Innovation: What are some of your day-to-day responsibilities as chief clinical officer at Privia?

Fernandez: I have responsibilities in the Houston market for value-based care in the Medicare Shared Savings Program. I also run the national physician advisory council, which looks at what we should be doing for physicians, for practices, for patients. We have several programs trying to help change the course of diabetes in the country: advanced illness management, advanced care planning, taking care of the sickest patients. We have also developed a national clinical leadership program. We put our physicians and clinicians through a one-year course that is two days every other month away from your practice, a very intense leadership course. We've seen just remarkable results with that and an engagement level that I don't think I've ever seen before. I also lead the clinical research program at Privia as well.

HCI: There are a few other high-profile physician enablement companies out there — Aledade and Lumeris, for instance. What are some things that are unique to Privia’s business model that draws practices to join it? And is it mainly primary care practices or also specialty groups? 

Fernandez: We're dominated by primary care, but we have a substantial number of specialists and multispecialty groups. In fact, a primary goal is to integrate the medical specialists with the primary care doctors. I think one of the differences between us and other companies is, in general, you have to change your EMR. If you listen to doctors, changing the EMR is one of the biggest hills to climb, and the other models don't make doctors do that. It is a serious advantage for us to have the vast majority of our physicians on a single EMR. That means our national team has to learn one EMR, our data analytics and medical economics people are dealing with one platform.

HCI: Which EHR do you use? 

Fernandez: We use athena. We will likely be using other EMRs in the future, just because to continue to grow we're going to have to change a little bit ourselves. The athena platform is an excellent platform for our purposes — the value-based care aspect, and our teams being able to work in that platform along with the physicians. It makes the job significantly easier.

HCI: Are there other infrastructure pieces that you standardize on for the clinicians, like other health IT modules that you make one decision on and then spread it out across the organization?

Fernandez: Absolutely. We have a national clinical IT advisory council, which engages along the lines of: Does everybody need their own choice of software on this or can we standardize as appropriate? It's really the physicians engaged in making a decision that is both business-wise and workload-wise a benefit to the doctors. It's been one of the main things that has allowed us to accelerate that process. It allows us to have physicians talking to physicians, and allows the businesspeople to stay out of the conversation, so we get very good adoption for the vast majority of things.

HCI: I kind of interrupted you when I was asking what makes Privia’s business model unique, and you mentioned getting everybody on the same EHR. Were there some other things you wanted to mention?

Fernandez: Yes, absolutely. We are partnering with a physician around their whole practice. Why do a leadership program? It's because we want those physicians helping not just their practice, but also helping other practices learn the people, process and technology ways of making the practice easier. We do the contracting for them. We have the payer contracts. For some, it’s just in the MSSP. Some others, it's just in Medicare Advantage. We do the whole package, commercial and Medicare. The scale and the team that we have, the expertise that we have, takes a big burden off of those practices. 

HCI: It sounds like you meet people where they are on their journey to value-based care. 

Fernandez: We do because some people may come in with some experience already, but for others, it might be new, or they're still mostly in fee for service. 

We talk about that in terms of maturation. The Houston market had many doctors who had already been in the Medicare Shared Savings Program so it started out as a fairly mature market. But in the Washington state market and the Abilene market, there was not a whole lot of that kind of activity. So we do meet them where they are. We have training programs, for instance, in value-based care. More importantly, we have a mentorship program We have physicians, nurse practitioners, and office managers who help so that people can get acclimated to the the environment more quickly. It's still a journey.

HCI: Last fall Privia announced a partnership with a company called Navina. Could you talk about some of the pain points that practices have gathering data that this work with Navina might help address?

Fernandez: When a physician is trying to care for a patient, having all of the information available about that patient is really important. As important is having the time for the physician and the patient to actually meet and decide what might be wrong and what might be the best course of action. What has happened to healthcare over the years is that a lot of that time has been sucked away, so the meeting with the patient becomes a little more transactional. 

So one of our primary precepts is that we need to take some of the burden off of the doctor. There are outside sources of information — HIEs, for instance, that are not seamlessly integrated into the EMR. There’s information that the payer has, and there are things that are in the EMR, but unintelligible. The Navina tool allows you to find things that chart prep work may not find. We've done a little work with them and found a significant number of things that we'd already looked for pretty extensively and hadn't found.

Also, when Navina finds something, you can then click on it and move it to to the appropriate place. We think this has improved our performance. It also helps with risk coding. One of the issues around risk coding is you want it to be accurate, right? Well-documented risk coding, not gaming. We are very, very serious about that stuff and our audit rates have improved dramatically with this tool. We're providing a much more accurate picture of that patient with this tool. 

HCI: Are you exploring other AI tools, like scribes for note taking?

Fernandez: I think it's important that our doctors experiment. We’re learning from that to find a path forward with the ones that might be the most successful.
 
HCI: I saw a blog written by Fred Taweel, M.D., who’s the chief medical officer for the Privia group in the Mid-Atlantic. He highlighted that you have recurring meetings, where practices’ metrics are transparently and objectively portrayed. He said you might think that would lead to finger pointing or blaming, but he said it doesn't have that effect. It fosters constructive conversations. Can you talk a little bit about why that's the case and your experience of those meetings?

Fernandez: Yes, and I would agree with Fred. We have built a culture in the group that we're here to help people, not just the doctors but the medical assistants and the office managers, too. 

At one of our recent retreats we assigned seating and put the data on the tables so that everybody at the table could see it. We purposefully put together the people who were getting A's on their report cards with people getting C's on their report cards. At first, they thought this was the silliest thing on earth. But by the end of the meeting, they said this is the best thing we've ever done, and it was because they were learning from each other.

HCI: It looks like Privia continues to grow.  Did I just see an announcement that it is entering the Indiana market? Do you work by finding an anchor practice in a new state and work with them, and then expand from there? 

Fernandez: Yes, we find an anchor partner. It usually takes us a while to find one that both is the type of practice we want to get and that wants to join us. We don't buy practices, which is another differentiator with many organizations, in particular, hospitals. So the engagement we get is not because we gave them a big check; it's because they have a vision. Many of them want to be in a physician-led organization. And they want to take really great care of patients and improve outcomes.