The transition to value-based care has led to consolidation and increased physician employment, but smaller practices may find different options in pursuing alignments with other organizations that don’t involve giving up their independent status.

Pressures on independent practices have led to physician ownership dropping below 50 percent for the first time, according to a 2017 American Medical Association survey. Regulators have also recognized the problem as well, with CMS proposing to exempt hundreds of thousands more clinicians from the new Merit-based Incentive Payment System (MIPS) in 2018. Scott Disch, MPH, vice president of performance management and operations at Privia Health, said it’s not just an issue of perception driving this trend.

“It’s a real problem for them,” he said to HealthExec. “It’s different managing—what I call ‘in your practice’ versus ‘on your practice.’ It’s a whole different component, skill set and technology.”

Disch’s presentation at June’s Healthcare Financial Management Association (HFMA) conference in Orlando focused on Privia’s experience as a physician practice management company, which he said has grown to around 1,600 providers in six states, 80 percent of them being in primary care. By aligning with a larger organization involving different primary care providers and specialists—whether it be as a virtual group, accountable care organization or a larger practice—physicians, he said, can choose to remain independent without sacrificing profitability or avoiding population health.

That choice comes with several hurdles, Disch admitted. Some are financial, like finding a partner with some capital, and others are operational, such as aligning with the right post-acute care provider and making sense of all the patient data across different practices.

“I really find across the country they struggle with not only understanding how to get the data to take action, but how do they set up the workflows to take the proper action each time,” he said.

Repeatedly in his interview with HealthExec Disch emphasized there’s no single correct model for independent practices to follow.

“I think it’s figuring out, for independent physicians, what’s the right angle to take,” Disch said.