Hartford Business Journal

www.HartfordBusiness.com • April 15, 2019 • Hartford Business Journal 13 "If we wanted … a very competitive price for the services we provided, we had to produce the best value and we had to be able to prove it," he said. Robert Kosior, chief operating officer of Farmington insurer ConnectiCare, said ProHealth has become savvy at managing costs and outcomes across its patient population. "They continue to be, quite honestly, one of the best-performing primary care groups in our networks in terms of their ability to manage the overall cost of care for the population they manage," Kosior said. He said the Optum deal should only strengthen those capabilities. One proving ground will be Optum's new Connecticut IPA — Optum Care Network of Connecticut — which consists of the 1,500 doctors that have banded together to negotiate con- tracts with insurers. So far, the IPA has signed Medicare Advantage contracts with United- Healthcare and Anthem. They're unique because of their risk structures. Under the deals, the IPA receives a fixed payment per patient from the insurers, and is then in charge of both delivering care and reimbursing providers. The contracts could mean greater losses for providers who don't meet certain quality benchmarks, like curbing emergency-room visits, but greater rewards if they do. Such contracts — known as "full risk" or "global capitation" — are rare in Connecticut, but seen as a way to better control healhtcare costs. "We're holding provider systems accountable for the value of the care being provided," Reed said. Optum's data analytics and ability to weather early financial swings is allow- ing the doctors to dabble in such risk- based contracts, he added. Insurers said they are keeping tabs on the effort. Kosior, of ConnectiCare, said his com- pany is having discussions with Optum about doing business with its new IPA. "We feel very positive about Pro- Health's capabilities," he said. "We hope they can set a standard for other providers to replicate." Doc option When ProHealth was founded in 1997, it merged approximately 145 doctors into one entity. Since then, it's added about 100 more to its ranks. One recent addition is Dr. Drew Ed- wards. ProHealth acquired his Prospect- based practice, which also includes Dr. Renika McLeod-Labissiere, in February. Edwards said he's been "staunchly independent" during his 26-year medi- cal career, but running a small prac- tice has gotten much more difficult. He said the last straw, ironically, was a $35,000 health insurance bill for his three employees. Being with a much larger group allows him to spend more time with patients, he said. He's also intrigued by ProHealth and Optum's foray into risk-based contracting. "It's really going to put them in good position to be able to enter that arena," he said. While ProHealth added 22 doctors last year, replacing retiring physicians and recruiting new ones for organic growth is an ongoing challenge, Reed said. A younger generation of doctors tends to expect a healthier work-life balance. In addition, it's still difficult to recruit into the primary-care specialty — which has been a large piece of ProHealth's business over the years. Though ProHealth's physicians help train dozens of area medical students annually, many of them ultimately end up choosing a more lucrative sub- specialty, Reed said. "One of the things we talk about very frequently here is we have to create the best practice environment for physicians to want to come to ProHealth," he said. He said ProHealth has made prog- ress on that front, but acknowledged it's one of a number of priorities for his successor. OUTSTANDING LEADERS OUTSTANDING LEADERS HAVE BEEN SELECTED! For questions about this event please contact Lauren Stroud at 860-236-9998, ext. 137 or email lstroud@hartfordbusiness.com For questions about this event please contact Lauren Stroud at REGISTER TODAY! WWW.HARTFORDBUSINESS.COM/OUREVENTS GO TO C-SUITE AWARDS TO REGISTER JOIN US | JUNE 5TH | 11AM-1:30PM HARTFORD MARRIOTT EVENT PARTNERS: PRESENTED BY: EDUCATIONAL LEADERSHIP SPONSOR: PRESENTING SPONSOR: EVENT SPONSOR: Dr. Drew Edwards and Dr. Renika McLeod-Labissiere are two of the latest additions for ProHealth, which acquired their Prospect-based practice in February. PHOTO | CONTRIBUTED

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