Physician Strategy: First Mover Advantage

In marketing terms, "First Movers" are defined by their courage to create a unique value proposition and move into or create markets that competitors have yet to create or identify. While there are some risks associated with being a first mover, the benefits often outweigh the risks and can lead to a profitable and sustainable competitive advantage and market position. On the other hand, "Fast Followers" are defined as quickly moving into a market after First Movers demonstrate that the market will deliver higher profits or unique value to the firm.

The new Medicare Quality Payment Program that began this year will create physician winners and losers where an equal number of Eligible Providers will receive a 4% bonus and 4% penalty. Some of the penalties can be avoided by transforming practices into Patient Centered Medical Homes...but that is not the only benefit.

More payers are giving increased reimbursements for those practices that become PCMH Recognized, but for Specialty Practices, there is an even greater financial benefit associated with PCMH or Patient Centered Specialty Practice Recognition. It includes being the first to market with PCMH Recognition where they demonstrate to the Primary Care Physicians, who represent the financial lifeblood of their practices with patient referrals, that they are willing to invest the time and resources to support the kind of high quality care PCPs have to demonstrate in order to become PCMH Recognized.

In terms of Care Coordination, PCPs must demonstrate the following for NCQA PCMH Recognition under 2017 Guidelines

Care Coordination and Care Transitions (CC)

The practice systematically tracks tests, referrals and care transitions to achieve high quality care coordination, lower costs, improve patient safety and ensure effective communication with specialists and other providers in the medical neighborhood.

For Specialty Practices, they are required to demonstrate the following under NCQA 2016 Guidelines

PCSP 5: Track and Coordinate Care The practice systematically tracks tests and referrals and coordinates care with the referring clinician and facilities.

One of the greatest challenges PCPs face when applying for PCMH Recognition is being able to demonstrate that they have polices/procedures in place, and can demonstrate that when they refer a patient for specialty care, they can get timely appointments, results and follow up from the specialist. Likewise, in order for a specialist to become PCMH recognized, they must also demonstrate the ability to coordinate access, care and information with the PCP in a timely manner.

Hence, the specialist who is first to market with PCMH recognition is not only able to earn more revenue from payers, they will actually help their PCP referral base increase their Per Member Per Month reimbursement in the process. This creates a unique value stream for both entities and gives the specialist a unique opportunity to market their PCMH practice to PCPs, build relationships, and increase their referral base.

Winners and losers will be determined under the new payment programs. Hence, PCP and Specialty physicians can develop strategies to either:

  • Play to win by getting increased reimbursement, bonuses and market share.

  • Play not to lose by avoiding penalties and simply trying to maintain market share.

  • Play to lose by incurring penalties and losing market share.

Which one of these strategies describes your practice?

Featured Posts
Recent Posts