Good medicine: Doctors' practice a classic Silver State growth story

HealthCare Partners Nevada tells a quintessential Silver State growth story.

The doctors’ practice opened shortly after the dawn of the modern-day megaresort era, and lassoed a new business model to become one of the state’s biggest practices.

And like the rest of the state, HealthCare Partners Nevada isn’t done growing. The model that spurred its expansion is coming to the rest of the medical field, thanks in big part to the Affordable Care Act. Now, the company is looking to put together a larger system that’ll bring its approach to more local patients.

To understand the practice’s future, start with its past. The HealthCare Partners story began in 1994, when primary care physician Sherif Abdou was wrapping up his residency at University Medical Center. That’s when a guest speaker told UMC residents that the U.S. health care system was broken, and would be bankrupt by 2020 unless doctors helped change how medical dollars got spent.

Abdou said that speech inspired him and business partner Amir Bacchus to open Summit Medical Group in 1996. The practice started small, with just five doctors and three offices. But it wouldn’t stay that way: It soon began hiring doctors and acquiring other big local providers, including Fremont Medical Centers, Rainbow Medical Centers and Canyon Gate Medical Group. It also snapped up practices in Boulder City, Pahrump and Mesquite. It merged with California-based HealthCare Partners in 2006 and became HealthCare Partners Nevada.

Today, the company is the largest physician practice in Southern Nevada, with 290 primary care providers and more than 1,700 specialists in 100 primary care clinics. It gained corporate cachet in 2012, when dialysis giant DaVita bought the entire HealthCare Partners family for $4.4 billion.

Abdou credited his practice’s success mostly to a growing embrace of its care protocol. From its opening, its Total Care Model focused on a unified approach that manages patient diagnosis and treatment under one roof. The goal is to avoid duplicate care and medical errors.

“Traditionally, physicians provided the care, and let patients figure out their way around the rest of the system,” Abdou said. “But we coordinate all aspects of their care. We believe it saves money. There’s a lot of waste in the system. If you put the right people at the right time and place, it will reduce the cost to patients and the payer.”

In an integrated model, patients typically have one provider who’s more hands-on than usual, from writing a long-term treatment plan to calling to make sure they’re taking their medicine. If cost is an issue, the provider calls the pharmacy to find a more affordable medication. The provider also coordinates follow-up visits and referrals. Integrated care, called the patient-centered medical home, was rare when HealthCare Partners opened in 1996, but it’s an idea whose time has come.

The Affordable Care Act, or Obamacare, gives financial incentives to providers that switch to coordinated care, and the Centers for Medicare and Medicaid Services classifies HealthCare Partners as a pioneer in the field. Plus, the Nevada Division of Health Care Financing and Policy is developing a patient-centered medical home for Medicaid.

Medical homes are also gaining traction among insurers. After a pilot program showed double-digit drops in hospital admissions and ER visits, Anthem Blue Cross and Blue Shield rolled out a nationwide patient-centered program in 2012 that reimburses primary care docs for saving money or creating comprehensive care plans for chronically ill patients. And the Nevada Health CO-OP, a nonprofit that will sell coverage through the Silver State Health Insurance Exchange, has patient advocates to guide members through the system from the moment they come in for a checkup.

Daniel Spogen, a Reno family doctor who chairs the Department of Family and Community Medicine at the University of Nevada School of Medicine, agreed that medical homes are the wave of the future. More importantly, they’re simply a better way to help patients.

“It’s more team-based. You’re looking at patient outcomes rather than the number of patients you see. It’s more preventive and proactive than it is reactive to medical problems,” Spogen said.

But beyond medical homes, there’s likely another reason HealthCare Partners is growing, Spogen said. Doctors are turning away from solo practice en masse, and joining corporations and hospitals as employees. Half a decade ago, 30 percent of family practitioners were employed with hospitals or corporate practices. Today, it’s about 60 percent. It’s just too tough for the independent doctor to join insurance networks, buy malpractice insurance and deal with other administrative headaches.

“I think a lot of doctors would prefer to be independent, but there are so many hassles to it,” Spogen said. “Being employed is not everyone’s first choice, but it’s the easiest choice right now.”

There are drawbacks to corporate medicine, Spogen said. For starters, the employee doctor loses some control over his scope of practice. The employer also gets a cut of profits.

Still, big practices such as HealthCare Partners are positioned to take advantage of coordinated care, Spogen said.

But the practice wants a team approach beyond primary care. Earlier this year, it bought Solari Hospice Care and Nevada Cancer Centers. The idea is to begin putting together a complete health system that lets providers access patient records at every phase of treatment.

“They’ll know what diagnostics have been done. When they go to a hospital or a specialist, they don’t have to start over. There will be a continuum of care that is seamless,” Abdou said. “We think that will lead to better outcomes.”

Abdou said HealthCare Partners also hopes to spearhead the creation of a fully integrated local health system with hospitals, doctors, rehabilitative care and academic research. Southern Nevada doesn’t have such a system now, and he said building one would mean more access and lower costs. The idea may scare providers who are afraid of losing their independence, Abdou said, but “health care is a team sport, not a solo sport.”

“It will take acceptance from other people, but once they see how an integrated system works, it will be the only way people receive care,” Abdou said.

Contact reporter Jennifer Robison at jrobison@reviewjournal.com or 702-380-4512. Follow @J_Robison1 on Twitter.