When history sets forth how the U.S. responded to the Covid-19 pandemic, there will be much to lament. But, posterity will surely remember numerous healthcare workers and organizations who served at the frontline to assist the community in their time of greatest need. Primary care physicians and facilities acquire a prominent position among those countless unsung heroes. Embedded with a mission to democratize healthcare, such independent physician-led facilities offer comprehensive, patient-centered care, demonstrating their significance in ensuring better health, better care, and lower costs. Unfortunately, their existence is at stake as over 50 percent of physicians today are receptive to becoming employees at various hospitals. A report by Avalere Health and the Physicians Advisory Institute (PAI) stated that 14,000 physicians left independent practices and entered into employment arrangements with various hospitals between 2016 and 2018. With budgetary concerns on the rise today, the trend that predates the last decade is still creating ripple effects in the industry, increasing the exodus of physicians from private practices to health systems. This results in the demise of several ambulatory surgery centers and private practices that can deliver high-quality healthcare in a much cost-effective manner than hospitals.

Having managed an ambulatory surgery center for several years, Michael Guarino identified the need to support and preserve independent physicians a decade ago and set on a mission to establish the Independent Physician Association of Nassau/Suffolk Counties (IPANS). This New York-based managed service organization provides them with a wide range of support services that help them stay independent and competitive.
While conversing with the MD Tech Review's editorial team, Michael Guarino, the Executive Director and founder of IPANS, shares his insights on how the organization leverages its wide network of independent physicians to provide unrivaled services to its members.

Could you give us a brief overview of IPANS?

IPANS is the result of my passion for assisting physicians in streamlining and optimizing their day-to-day operations and staying independent. Founded in 2011, we’re a non-exclusive, not-for-profit physician-led Independent Physician Association (IPA) that is solely focused on helping independent and community-based physicians remain on the frontline of healthcare.

At IPANS, we specialize in helping our members with a wide range of services, including — but not limited to — payor negotiations and collaborations, practice management, billing and collections, clinical care management, group malpractice savings, and human resources. This way, we take over their most complicated administrative functions, enabling our physician partners to keep their focus intact on the most important aspect of healthcare, the care of their patients.

Today, IPANS serves as one of the fastest-growing and largest multi-specialty IPA in the U.S., supporting more than 2800 independent physicians across the country. Our mission is to improve the quality of healthcare and ensure that patients receive the ‘Right Care, at the Right Place, at the Right Time.’

What are some of the key challenges that independent physicians face?

Receiving timely reimbursement and maintaining price transparency are some of the major hardships they face when it comes to managing a private practice. Evidently, an independent doctor lacks the ability to negotiate with medical insurance providers and attain a fair and equitable representation for reimbursements. Most importantly, with the shift from a fee-for-service model to a value-based care approach, showing their proficiency in delivering value-based care is no easy task for private practices.

This is precisely where IPANS makes a world of difference. Much like the saying, “Unity is strength,” the coalition of a huge number of independent physicians allows us to negotiate plans with insurance providers and provide ideal strategies to each member according to their requirements. We also provide them with an additional layer of support with our dedicated clinical care management team that encompasses physicians, physician assistants, registered nurse case managers, social workers, and more without depleting the doctor’s payroll.

Could you elaborate on the potential benefits a physician can achieve with IPANS?

A physician can join IPANS for free and receive enhanced reimbursement from participating health plans and a plethora of other services while remaining independent. They become a part of a value-based program where they can receive exceptional bonuses. This is exactly what makes us stand away from the competition. Primary care physicians can have enhanced contracts secured for them via a messenger-model approach that contracts with Medicare Advantage and commercial payors on their behalf. We also provide them with best-in-class billing services and unrivaled management services ranging from full management of office personnel to handling of back-office functions.

Group Malpractice is another area that IPANS excels at. With our exclusive purchasing group program, we help physicians save 20-60 percent on their malpractice premiums. Furthermore, unlike other IPAs, we go the extra mile to empower our members with the necessary technology to stay ahead of the curve. At IPANS, we help them with IT data integration and provide them with applications to excel in remote patient monitoring and chronic care management.

What are some of the key factors that differentiate IPANS from the competition?

What makes us different from other IPAs is that we’re not affiliated with a hospital system. While most IPAs are owned by a hospital, we’re a purely membership-driven organization that continues to work on supporting our members to provide the best care and ensure price transparency. For example, a colonoscopy performed at a hospital can cost $4,000, while the same can be done at a surgery center for $600 by the same doctors and ensuring the same quality in care delivery. Identifying that the public is not really aware of the price transparency independent practices deliver, we’re now focusing on educating the people.

IPANS’ value proposition was well manifested by its operations during the pandemic. It received a call from New York City H+H in the height of the pandemic to build a team of operators and clinicians that would eventually field thousands of 911 calls in an effort to help support the care of those in need. This team helped thousands of patients through a telemedicine platform. This was a major undertaking; however, when the need arose IPANS was there to help.

What does the future hold for IPANS?

As a coalition of several like-minded people who intend to succeed, we’re able to make a paradigm shift in the way independent practices operated by streamlining care management to reduce healthcare costs in a way that benefits both patients and physicians. And, our strategies are purely focused on a collaborative growth model, where we'd aim to serve as the best provider in the industry rather than the biggest.

Moving ahead, IPANS is working on bringing new applications to the table that can help its members better provide care to their patients. We already developed glucose guards, a diabetic management system that enables physicians to monitor their diabetic patients remotely. It runs on a gamified platform, where patients can earn rewards that can be later turned into Amazon gift cards. This way, we aim to engage with patients in a more effective way to help them make the right decision based on quality and costs.