On Nov. 25, two San Francisco-based healthcare organizations announced a new strategic relationship. Altais Clinical Services, a division of the healthcare services company Altais—initially launched last year by Blue Shield of California—and Brown & Toland Physicians, an independent network of more than 2,700 physicians serving more than 350,000 patients in the San Francisco Bay Area—on Wednesday completed their affiliation. As a press release published on Wednesday morning stated, “The two organizations have formally joined to expand the transformation of patient care for improved health outcomes at an affordable cost and accelerate the improvement of the physician and patient experience. Brown & Toland Physicians is now a subsidiary of Altais Clinical Services. Kelly Robison remains Brown & Toland Physicians’ chief executive officer.”
The press release noted that “Studies recently cited by JAMA Network demonstrate that widespread physician burnout is a major contributor to the current shortage of physicians in the United States. Some of the factors creating this burnout include the significant time required by physicians to manage electronic health records and the increasing complexities of operating a practice. These and other pressures take physicians’ time away from caring for patients. The COVID-19 pandemic has exacerbated the problem, according to the New England Journal of Medicine.”
Under the terms of the agreement, “Brown & Toland Physicians will continue to operate under its current brand and continue to service all payers. As part of Altais Clinical Services, Brown & Toland Physicians now has access to additional capital, services and a wide range of programs and tools for physicians to operate independent practices under a value-based model. All Brown & Toland Physicians’ patients can continue to see their physicians with no interruption in care.” Meanwhile, “As part of Altais Clinical Services, Brown & Toland Physicians will continue to provide a clinically integrated system of coordinated care to ensure its physicians spend time doing what they do best – caring for patients. This includes sophisticated clinical tools and a technology management platform to enhance clinical and service quality for physicians and their patients.”
In a statement contained in the press release, Brown & Toland’s Robison stated that "Altais Clinical Services and Brown & Toland Physicians share the vision of a reimagined physician practice experience. We will serve as an innovator for independent physicians, providing deeper levels of support and the tools they need to deliver high-quality, affordable care to their patients in this increasingly value-based world. Physicians will benefit from a more robust practice management platform that uses an advanced set of data, insights and tools to care for patients where and when they need it.”
“We at Altais Clinical Services are delighted to have Brown & Toland Physicians join us. Together, we look to bring even greater value to physicians. Our goal is to accelerate the capacity of physicians and the clinical community to maximize the health and well-being of their patients and set practices up for long-term success,” said Jeff Bailet, M.D., Altais’ president and chief executive officer, in a statement contained in the press release. “Our focus is to restore the vibrancy of independent physician practices, so they can direct more of their focus on patient care.”
This week, Dr. Bailet and Kelly Robison spoke with Healthcare Innovation Editor-in-Chief Mark Hagland regarding the origins of the strategic partnership and the partnership’s trajectory. Below are excerpts from that interview.
Can you tell us about the background and developments leading up to the strategic partnership?
Jeff Bailet, M.D.: I was in Wisconsin leading the Aurora Medical Group for 14 years. That group is pretty high-performing. I’m an ENT surgeon—I practiced clinically for 24 years—and I was practicing in Wisconsin before I moved to California in 2019 to work for Blue Shield of California. All of the quality and affordability, contracting, physician relationships, disease and care management, and pharmacy management, functions reported up to me there.
And it became clear to me that there was a lot of disruption that patients were experiencing [in California and elsewhere]. Physicians were feeling incredibly burdened by the administrative burdens, were burning out, and were retiring early. And that was incredibly disruptive for patients. So it became clear that we needed to help the physicians; the problem is pervasive. And 50 percent of the physician community felt disenfranchised and burned out before COVID-19, and now it’s 60 percent; physicians feel personally and financially exhausted.
And the independent physicians don’t have the tools to be successful. So Blue Shield said, we’re going to need to start a new organization to help physicians. And while blue Shield is the founding investor, we work with all the payers. So that is how Altais came about. We were founded on June 1, 2019. And we provide tools, technology, and support to physicians, and are making investments in their practices. And while employment is an opportunity, there are different possibilities.
Kelly Robison: Brown & Toland is structured as an IPA [independent practice association]. We do employ a small subset of physicians. And what Altais is doing—it makes perfect sense that Brown & Toland, with 2,700 physicians in an independent setting in Northern California—is the first participant in this arrangement. The vast majority of our physicians are contracted, so they’re small business owners. We provide the support and tools, contracting, UM, and clinical decision support. So while we provide more of the management services for population health, what Altais is doing is creating additional tools and technology that can be used in the practice. So the management services backbone, along with tools for the practice setting.
So Brown & Toland is the first of what might be a number of IPAs under the Altais umbrella?
Bailet: Kelly’s organization is a very sophisticated IPA, in business over 28 years, and that talent will be very helpful for us. Many independent medical groups and potentially other IPAs are reaching out to us for help. Even health plans are reaching out to us. So that’s the activity that’s going on. I can’t share with you who’s talking to us, but yes, the way we’re setting up the organization, other IPAs could lock arms with us and join our organization.
So you’ll be providing umbrella-level help with contracting, IT, and clinical decision support?
Bailet: Yes, that’s what Brown & Toland is doing today for their physicians, and we’re helping them with additional investments in technology, and will make investments in Brown & Toland to help them accelerate the strategy that they have in place. And Brown & Toland will remain intact. Kelly’s doing a fabulous job running her organization, and will continue to do that.
Robison: It would be helpful to talk about the market landscape. There’s been so much consolidation; the industry is moving very quickly. And information technology is more important than ever. And it’s gotten harder and harder for physicians to invest in IT; but studies have shown that the quality can be higher in open IPA practices. And helping practices remain independent is good for quality of patient care and patient satisfaction. So let’s help independent physicians remains viable.
Bailet: There are a lot of physicians who would like to remain independent. There’s something alluring about independent practice, but if you don’t have the tools and the knowledge, it’s very tough sledding for independent physicians. We want to talk away the burden of practice.
So the day-to-day control of their independent practices won’t change for the physicians?
Robison: That’s right. They stay independent; they have the option to change their model of practice. But now we’re a subsidiary of a much larger organization that can really help with sustainability and affordability over time, and with support for those practices.
How will the landscape around physician practice evolve in the next two years?
Bailet: COVID really exposed the lack of resilience in the medical system, and how fee-for-service payment really is not sustainable. COVID really exposed the underlying challenges with fee-for-service. And a lot of practices are no longer in business, because they lost 70 percent or more of the revenues early on. And even some sophisticated integrated health systems are really struggling right now. And that was an “aha” moment, where physician leaders realized that had they had more value-based contracts, they would have done better during COVID. But you need the infrastructure, the analytics, including predictive, and clinical decision support, to be successful. Organizations like Brown & Toland are being successful because of their having innovated. And the other key element is technology. And the folks at Brown & Toland drove the uptake of telehealth 65 percent in a number of weeks. So there was the acknowledgement of how powerful technology can be if it’s deployed in the right way. So there’s an awareness among medical group leaders that they need to pursue value, and that they need technology to do that. I serve on the Physician Panel for HHS, we review proposals with stakeholders across the country, we work with CMMI [the Center for Medicare & Medicaid Innovation, a division of the Centers for Medicare & Medicaid Services]. So designing a comprehensive model is really, really difficult, but I think the payers are wanting to get into this space more forcefully, but they need a high-performing group of physicians who are engaged and who want to take on the value contract, and have the support and the infrastructure to do well. It’s the PTAC, the Physician-Focused Payment Model Technical Advisory Committee. It was created under MACRA [the Medicare Access and CHIP Reauthorization Act of 2015].
Robison: I think that the next couple of years are going to be really challenging, even with the fantastic news about the vaccine. COVID’s here to stay for a while and will have a direct impact on how physicians practice. So helping physicians to bridge this time period will be important. The technology of telehealth is here to stay. And physician groups are bringing in social determinants in important ways. And Jeff uses this phrase a lot, about trying to decrease the burden on physicians in practice. And while Jeff and I are excited about this deal that took a long time to emerge, the timing couldn’t be better. Physicians need a little bit of assistance to bridge this time when there’s been a dip in elective care. So the more we can do to decrease the burden on them in value-based arrangements, to keep that cash flow as steady as possible, and then the technology and other things to make their day-to-day lives easier, that’s really where we need to focus our energies.
What are your thoughts on the new administration coming in?
Bailet: It’s hard to say. I was appointed by Sylvia Burwell under the Obama administration, and worked with [Health and Human Services] Secretary Tom Price and now Alex Azar. The majority party changed, but a lot of the work around value and trying to make healthcare more affordable for Medicare beneficiaries, a lot of that work continued forward. I would not expect a significant left or right turn. There may be some modifications or nuances along the way, but I would not expect a dramatic shift away from value.
Could it accelerate the shift to value?
Bailet: I ‘m not sure, because CMS has been pretty driven to get value-based models into the field.
Robison: I agree with Jeff; I don’t see any major, dramatic shifts. The current administration was on the path of starting to peel away from the ACA; we’ll see more support for the ACA in the new administration. But CMS has been trying to be very progressive in terms of getting more and more patients into value-based care, and I think that that good work is going to continue.
