Huron Valley Physicians Association: Dr. Paul Harkaway, President

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Approximately 700 physicians—25% primary care and 75% specialists—are members of the Huron Valley Physicians Association (HVPA), an independent physician association which incorporated in 1983. HVPA brings together privately owned and hospital owned practices, primarily in the Ann Arbor area of Michigan. All members have admitting privileges to St. Joseph Mercy Health System hospitals, or provide inpatient coverage through an HVPA participating physician group.

Increasing Connectivity

“Our main work over the years had been managed care contracting and quality and performance improvement under that banner,” says Dr. Paul Harkaway, President. “That has evolved over the last few years to focus more on the quality, utilization, and improvement side of things independent of contracting. We have worked diligently on connectivity between providers as a means to enhance that effort.”

If you were a patient coming to see a physician member of HVPA, you would be visiting an independent business entity with preferential tools available to them through the network of connectivity that HVPA provides. For instance, a robust e-prescription system helps doctors to take better more efficient care of patients; and we have prioritized it given the immediate advantages it provides.

Our work if successful would assure that, if you suffered from any chronic disease, that information would be available in  a functional easy to  use registry and your physician would be able to easily access your details and be prompted as to the type of services you required, what tests were due, and what kind of education you might need to understand more about your condition. Were you to be sent to a specialist within the system, your basic health history would be electronically communicated to them. The specialist would know why you were being seen, the specifications of your referring doctor, and what they and you hoped to accomplish.

In addition, there would be information available as far as efficiency of care issues. Tests would not be repeated. The system would be set up to avoid excess testing, anything beyond what you need to get to the right conclusion.

“That’s the vision,” says Harkaway. “We are a community of practices that maintain the spirit of the small business. Our doctors have intense pride in ownership and make sure that they are good at what they do, as opposed to a larger model where the spirit of individualism and pride in ownership may not  be quite the same.”

Developing Organized Systems of Care

The big questions for independent physician associations are where to get the resources to do this type of work and how to keep hundreds of individual business entities moving in the same direction. For HPVA to succeed, it needs to create a shared vision and find a way to sustain that vision while honoring the independence of the individuals that make up the group. “First we have to get them to want to cooperate, and then we have to find a way to build in additional  accountability,” says Harkaway.

HVPA has not committed to an electronic medical record at this point in time because Harkaway feels that the capabilities of the EMR have not yet caught up with the marketed promises. “In this country, as far as I’m concerned, chaos understates the matter. The myriad of different vendors with a myriad of different products, most of which don’t really deliver the capabilities that we would need and don’t play with each other is nothing if not confusing. I think the lack of a more focused vision around IT in this country leads to a lot of waste,” he says. Hopefully somebody is explaining this to OBama

The group advises their smaller private practices to take their time before investing in EMR systems. They’d rather see members work on developing some of the other tools available to them, such as e-prescriptions and ways of growing more connected with the healthcare community with the goal of evolving toward a complete EMR down the road.

“Rather than struggle with how to connect different EMRs, we need to march to a single vision and evolve incrementally to meet that vision as a community,” says Harkaway.

Finding the Balance: The Role of an IPA

There are multiple forces in the healthcare community—payers and providers, hospitals and physician groups—and Harkaway sees the independent physician association as one way to connect those scattered entities and help achieve common vision and focus. “We take the independent practices and try to figure out how to get them to function like a fully integrated multispecialty group,” he says.

“I think that there is a sweet spot here where they can maintain their independence around a certain number of issues. They can maintain their pride in ownership, maintain their cultures, and even maintain a sort of a family feel to their practices, but they still have to have a level of connectivity to the community that allows them to benefit from all the things a larger entity might benefit from.”

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