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Speaking the Language: Health Care Execs Join United Rheumatology to Advocate for Independent Practice
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In the ever-changing landscape of the United States health care system, rheumatologists need a voice. They need a voice in managing the complex web of drug pricing structures, a voice in developing clinical guidelines, and, on a fundamental level, a voice in simply communicating with all the players involved in running the day-to-day operations of a rheumatology practice.
As the nation’s “only physician-led organization supporting independent rheumatology practices,” representing more than 550 providers in 37 states, United Rheumatology hopes to be that voice.
Two individuals who hope to reach that goal, among many other goals, are Douglas K. Tardio, who recently assumed the position of CEO, and Jim Albano, who came on as executive vice president of Payer Strategy and Operations.
Located in Hauppauge, New York, United Rheumatology offers services such as membership in the Group Purchasing Organization, which helps practices buy everything from biologics to office supplies; the Practice Administrator’s Committee, which helps practices optimize workflow; free travel to national meetings, where players in all facets of rheumatology can discuss issues in the field; and participation into the Clinical Pathways program, which aims to develop best practices guidelines.
Participants may also voluntarily join the Care Network to help rheumatologists communicate with managed care companies, and the Normalized Integrated Community Evidence data warehouse for deeper understanding of practice patterns. Members of United Rheumatology also have access to an extensive library of materials ranging from CME opportunities to clinical practice guidelines to information about business.
Healio Rheumatology spoke with Tardio and Albano about their new roles in United Rheumatology, how practicing clinicians can get involved, and what to expect from the organization in the coming years.
Q: As new additions to the United Rheumatology team, what can we expect from the organization?
Tardio: I became the new CEO for the organization in January, but I have been on the board of the company since it was founded by Max I. Hamburger, MD, in 2014. If you look at the company’s incoming management team, we have extensive health care experience working in the benefit management space and working for health plan payers. For example, William Moore recently joined us as chief technology officer, but Bill and I worked together for over 8 years at CareCore National — now eviCore Healthcare.
United Rheumatology, as you know, has been growing significantly over the last 4 years, eclipsing 500 members in January 2019. We set out on a clear mission to support independent rheumatologists. We have been listening to our members and responding with new and innovative programs, and the resulting new member applications have been especially rewarding to our team. There are many different initiatives underway; some are purely operational, where we consider how to support rheumatologists in dealing with EHR vendors or revenue cycle management. There is also a group purchasing organization that assists our members with the acquisition of drugs, which supports our members significantly.
As United Rheumatology has grown, one of the founding principles has been to develop evidence-based guidelines for various disease states in rheumatology. These are developed by our Medical Policy Committee, which consists of roughly 30 rheumatologists across all settings, from solo practitioners to some of the largest groups in the country at major academic centers. We have even included international participants to gain their insights on standard of care. These guidelines are the core of our engagement strategy in dealing with health plan payers.
Our guidelines are both reflective of how our members care for their patients and how we as a community of rheumatologists embrace evidence-based medicine and value-based care models. Beyond the guidelines, we hope to continue to grow our network. What appeals to all those individual practices is that United Rheumatology is trying to be their voice in day-to-day work; we are trying to offer them real, useful solutions in developing collaborative approaches with health plan payers.
Albano: I joined in February of this year as executive vice president of payer strategy and operations. Most of my career has been involved with health plans: I have managed networks and worked in physician and hospital contracting. My role here is to build out the profile and awareness of United Rheumatology as an organization supporting and sustaining rheumatologists in practice, and develop relationships between those rheumatologists and United Rheumatology.
All of these functions are a foundation for value-based arrangements with payers and employers to leverage pathways and programs that United Rheumatology has piloted with member practices. We offer care coordination for rheumatology patients so they can access other specialties when that makes sense. Our goal is to quarterback the care of those patients, and my role is to reach out to payers and employers so they understand who United Rheumatology is, and then work on real arrangements for them.
Tardio: In my career in health care, I have worked with and for health plan payers, including Aetna and Oxford Health Plans. I also spent 12 years as president, chief operating officer and then CEO at CareCore National, a benefit management company managing radiology, cardiology, musculoskeletal care and other specialty areas. What is important about that background is that we sat on the side of payers developing solutions. Now, I am using that knowledge and expertise sitting on behalf of rheumatologists. We are helping our members build collaborative relationships with payers and bring physician views and solutions to care delivery.
Additionally, we have made a commitment to clinical data at United Rheumatology. As I mentioned, chief technology officer, William Moore, was at CareCore National and he spent much of his time looking at high-volume clinical data. We are leveraging Bill’s unique perspective on operationalizing data to provide value back to our members and to United Rheumatology. We believe the organization has the largest set of independent rheumatology clinical data in the country, and we are working extremely hard to pull that data in and operationalize it. In this way, we can truly develop value-based programs working with our members, their patients and payers. These data can really differentiate us in the marketplace; it is not just about clinical research.
Q: How are you helping rheumatologists deal a potential influx of new drugs in the specialty?
Tardio: Clearly, there is going to be more choice; unfortunately, at least today, that choice is limited by formularies. I know that United Rheumatology and our physician community would like that choice given back to them, letting individual physicians make the best choice for their patients. Today, we don’t believe that is available because of health plan formularies or intermediary formularies. That triggers prior authorization, which puts the administrative burden back to the physician community. We believe that by working with a payer at the rheumatologist level, we can step into the role historically held by pharmacy benefit managers. This will be critical in the future to develop precision models at physician-patient levels.
When a patient is ill and needs certain drugs, we can help with when to order them and share the information with patients in real time. At the moment, what often happens is that a physician will select a drug, share this selection with their patient, then find out later that it was not on formulary or not approved. The physician will then have to go back to the patient to switch; that sequence of events, placing the burden on a patient, is simply wrong. A physician should be able to select a therapy and provide singular guidance to the patient while the patient is in the room.
Q: How is United Rheumatology helping physicians deal with fluctuating prices of these new drugs in the rheumatology market?
Tardio: Drug pricse fluctuate for many reasons, but ultimately rebates and proprietary negotiations create a sense of apprehension. We think there should be more transparency in drug pricing overall. With significant increases in patient out-of-pocket expenses, they are asking questions and making decisions based on cost. That is, in fact, what they were asked to do.
However, at the same time, we have not made it easy for patients to understand the costs, especially with respect to their drugs; and not only the cost to them but to their employer. Our member physicians are willing to have the dialogue with their patients about cost but they need a willing health plan partner. We are positive about the fact that there will be more choice. There will be opportunity for more fair and transparent pricing that will ultimately benefit patients.
Q: How can members actively participate in the United Rheumatology community?
Tardio: There are conferences throughout the year and we have been extremely pleased with the turnout of members who attend these conferences. Presenters include influencers out of academic centers, international speakers, as well as people speaking on behalf of the government, the payer, and commercial carriers. Our efforts are always to be in touch with our membership. There is communication at the physician level, where doctors can have peer-to-peer conversations, but we are also interested in communication at the practice level, where practice managers can speak to our staff.
Practice managers are important to understanding the challenges of running a clinic today, operationally as well as clinically. The other piece that is important is understanding the financial challenges, particularly for solo or small group practices today. At United Rheumatology, we want to help these practices and offer an alternative to selling their practice to a hospital. Now, every sale to a hospital is not necessarily bad, but it is important for independent practices to understand their options. Our members can look to us as an advocate, a collective voice offering support. We always want to be expanding our scope of services based on what we hear from our membership, and this happens when members participate and share feedback.
Albano: To build on one other thing Doug referenced, practicing physicians will be at the table with us with payers. Payers do not usually have this type of clinical expertise in house, and are unfamiliar with the programs, pathways, and care coordination approaches these doctors are using each day — payers need to be aware of these. It is going to be our role to influence how these payers think about this going forward.
Tardio: It’s hard for physicians to look out 2 to 3 years, dialoguing with payers about what is going to happen with drug prices moving forward and what that is going to mean to their practice or their viability. At United Rheumatology, we need to fill that void, look out on the horizon, and help build collaborative relationships with payers and our members that mitigate both practice risk and payer risk.
Q: What are some of the long-term plans for United Rheumatology?
Tardio: We are very excited about the future of United Rheumatology. In our first 4 years, Dr. Hamburger and the team worked to build a national network and community of rheumatologists that was not defined by one city or state. United Rheumatology wanted to speak on behalf of the community. Now, we are excited to work collaboratively with payers. We are thrilled to help rheumatologists in moving from a hospital setting back to independent practice, to be able to hold their hand and help them set up a practice. One of our goals is to provide financial strength to do that right out of the gate.
Over the next several years, we hope to work even more closely with our member practices. It is fair to say that physicians did not go into independent practice to make a decision on what electronic health record to buy or how to improve their revenue cycle management; they wanted to take care of patients. We want to take the administrative burden off their shoulders while protecting their rights to unobstructed patient care.
In addition, data will become incredibly important over the next 3 to 5 years, and we hope to help in that area, as well, as we move from 750,000 to a million members’ worth of clinical data. No one else has that kind of data. If we can clinically leverage that information, then we can move to precision-based medicine. We strive to sit at the epicenter of that movement in rheumatology. – by Rob Volansky
For more information:
Jim Albano and Douglas Tardio can be reached at 150 Motor Pkwy #108e, Hauppauge, NY 11788; email: jlott@unitedrheumatology.com.
Disclosure: Albano and Tardio report no relevant financial disclosures.