Integrated Medical Services (IMS) is the largest physician-owned multi-specialty provider group in Arizona, with more than 75 providers across nine specialties. IMS CEO Monique Delgado recently spoke with Healthcare Innovation about the provider group’s growth and its involvement in value-based care models.
IMS had previously been owned by the Dignity Health System, but became an independent provider group in January 2023. Since becoming independent, IMS has experienced a 30 percent growth in providers, including five new locations and two primary care practice acquisitions in just one year, and now serves more than 20,000 patients across the value-based care continuum. In addition, IMS reported a 92 percent patient satisfaction rate as measured by an external survey partner, a metric that improved significantly over the past year.
Speaking about her background, Delgado said that when ACOs came on the scene about a decade ago, she joined one of the first ACOs in Arizona. “I had the privilege of working across the entire valley with primary care and specialists to help educate and train providers on moving from fee for service to value-based care and accountable care. So over the last decade, I supported primary care independent practices through an ACO or IPA model, and then came over to help IMS scale the organization and gain their independence back.”
Delgado said she has spent the last year unraveling some of the contracts IMS was in. “IMS historically had not really taken advantage of its size,” she explained. “We are the largest independent multi-specialty group, the largest independent practice in general in Arizona and we didn't have direct contracts with the payers. But really we were too large to be with an aggregator. It doesn't make sense for us. We have enough skill to have direct contracts with the payers, so I've strategically looked at each contract where it made sense for us to go to risk directly and we've successfully been able to negotiate those contracts and move them away from the aggregators.”
In previous organizations she led that were in primary care with risk-based contracts, she explained, one of the hardest things to control was the total cost of care, and the majority of that is professional spend. “You’re trying to work with 20 different specialists. Here, we actually have them under our same umbrella, so we can identify cardiology spend and we can apply a clinical protocol if we need to. Our ability to coordinate more effective care with our own cardiologists actually creates better compliance. We have much better control over that total cost of care.”
Delgado said one of the keys to success is the provider group’s deepening relationship with health IT vendor athenahealth, and the creation of a single health IT platform across the organization. Historically, she said, having multiple EHRs has been a big challenge in value-based care and population health efforts. “In my previous roles, where we had multiple practices, you might have 55 disparate EMRs that you're trying to aggregate. So here we have one instance, one product,” she said. “Athena customized different templates within the system so that you can have the system work for cardiologists, work for PCPs and work for our orthopedists. We have a single instance and the patient has one record. That has been tremendously helpful. Any provider that we bring on or any any practice that we acquire comes onto that instance.”
As IMS integrates practices, it can do that seamlessly because it brings them onto the same system that everybody else is on, Delgado said. “In addition, we’re independently owned and physicians can come in and actually be owners of of the organization.”
She said the revenue cycle support is strong as well. “We have some of the best stats that I've seen in independent practices and partly that's due to the relationship we have with athena. For instance, we run a 3.9 percent denial rate. The average standard is like 6 percent, so that's huge. In regard to data analytics, we’ve deployed a new functionality, Data View, with athena, and that takes all the back-end data that we have from athena, and it can ingest the external data that we're getting from our payer partners, which allows us to take the real-time data of what we know is happening in the clinic with the patient and also that trended data so that we can get a better view of what's happening in our population and apply interventions, clinical protocols, or outreach to the patient as needed.”
“If you wait on the payer data that you get, you're behind, because there's a claims lag, so you're looking at what's already taken place. We can actually see ahead of what the health plan has before the claim has even been submitted,” Delgado said. “We know what's happening with our population, and that certainly helps conversations when we're meeting with our health plan partners.”
