November 24, 2018 by Matthew Weinstock for Modern Healthcare

Q&A: Summit Medical Group CEO Le Benger on the move to alternative pay models

As appears in Modern Healthcare, by Matthew Weinstock

With nearly 900 providers practicing in 70 locations, Summit Medical Group has a big reach. The well-established New Jersey independent multispecialty physician group 
sees roughly 850,000 unique patients yearly, with about 1.5 million patient visits. That reach doesn't mean that Summit is complacent though. Under the leadership of
 Dr. Jeffrey Le Benger, the organization has moved aggressively into alternative payment and quality contracting arrangements. Le Benger, chairman of the board and CEO of Summit, spoke with Modern Healthcare Managing Editor Matthew Weinstock. The following is an edited transcript.

MH: Does the pace of consolidation in the industry concern you as you think about the continued viability of your practices?

Le Benger: There's a big difference with consolidation and integration. Hospital systems consolidate. There's a very hard time integrating. We have about 900 providers in the medical group and with our governance and leadership track, we really try to integrate them into a very specific culture. That is something that keeps me up at night: How do we develop that culture in 900 provider organizations?

We are physician-owned, physician-run and our doctor leaders are the ones who run the clinical platforms at this group. All the way from episodic clinical pathways to how you run the healthcare delivery model, to how you compensate the doctors. 

What also keeps me up at night when it comes to consolidation is the competition for the attributed patient, because everybody wants to move that scale from fee for service to value, but all the way over to value where it's the premium dollar, not a shared savings and not pay for performance. To do that, there is a competitiveness to grow your primary-care base to get it so you're able to manage that risk. 

MH: What percentage of your patient population is at risk?

Le Benger: About 65%, moving to about 70%.

MH: Is that working for you financially?

Le Benger: Over five or six years, we've grown from 200 providers to 900, and we have less than 2% turnover for providers. That's due to the culture of physician leadership and governance. The other thing that we have done really well is we moved from a full PPO world—a full fee-for-service world—to an HMO world. Patients still get treated the same. On the backside, we understand care management, transitions of care and gaps of care. We have a large population-health department that manages the sickest 5% to 7% of patients within the organization. 

We have a huge population-health budget, and it was a loser at first because it has to do with the scale of that population and you have to have scale with your data analytics. It takes a while to get in there. But we were fortunate because we were big enough that we had leverage with our pricing at first in the PPO world. That gave us a lot of operational cash that we were able to beta our products, moving into value.

MH: Claims data is sort of the holy grail for doing all of this work. How have you managed that piece?

Le Benger: We mandate in all our contracts that we have to have claims data.

MH: You've been involved in Medicare accountable care models, including the NextGen, but we've also seen the CMS carve out physicians from needing to comply with alternative payment models. Where do you think we are heading?

Le Benger: I don't know yet. The government, at a macroeconomic level, is trying to bring down the costs. I look at it in the micro—as the individual doctor looks at it—how's it going to affect him? You have to look at fair market value—how people are going to be paid and how quality metrics are paid and how they're going to justify the payments. I just know that like in a casino, the house always wins. They're looking at the macroeconomic, and I do feel that they're going to narrow the coding so it's easier to rectify the billing procedure because, no matter what, Medicare has always, and will always be based in a fee-for-service world. 

MH: What do you look for when you consider bringing a new practice into the fold?

Le Benger: Believe it or not, a lot of our growth has been with four physicians. We've taken in some very large groups, but when we've taken in the large groups, we look at the culture. We want to make sure that they're looking out for the patient.

We have an integration team and the chiefs of our departments who meet with the practice. We were moving down the line with a lucrative deal for one group but there were one too many with flags that occurred, some with quality, some with billing, so we decided to walk away. We would just not do it for the economic value.

MH: I recall reading somewhere that you said it takes a year or two to fully integrate into Summit. Why is that?

Le Benger: They're used to their autonomy. They're used to how they run their practice. We are very transparent at the organization and we are uniform about how we handle administrative events and management issues. 

But once they get used to the clinical model, and they understand that what we do is to always drive the healthcare model to benefit the patient, that's what 
sells it.

MH: Burnout is a big factor for physicians these days. How are you managing that?

Le Benger: I don't know if consultants made this up or if it's real. I think it's physician exhaustion. But we surveyed the entire group, and we went through this. 

We even brought in the advisory board to discuss physician burnout at one of our group meetings a couple years ago. I don't know how many groups are doing this, but my chief of behavioral health is running our physician engagement. So we are really managing, via the chief of behavioral health, provider engagement to the max.

MH: Since you used that term exhaustion and not burnout, do you think burnout is a real factor, or is it being overplayed?

Le Benger: I do think it's a real factor on a very small select population of physicians. I think the vast majority have exhaustion. 

What we've also done that came through in provider engagement is that we have scribes going out to our doctors, and we found out that the productivity increased by 14% with the use of scribes.