title: Large Independent Primary Care Medical Groups.
abstract: OBJECTIVE
  In the turbulent US health care environment, many primary care physicians seek hospital employment. Large physician-owned primary care groups are an alternative, but few physicians or policy makers realize that such groups exist. We wanted to describe these groups, their advantages, and their challenges.
  
  
  METHODS
  We identified 21 groups and studied 5 that varied in size and location. We conducted interviews with group leaders, surveyed randomly selected group physicians, and interviewed external observers-leaders of a health plan, hospital, and specialty medical group that shared patients with the group. We triangulated responses from group leaders, group physicians, and external observers to identify key themes.
  
  
  RESULTS
  The groups' physicians work in small practices, with the group providing economies of scale necessary to develop laboratory and imaging services, health information technology, and quality improvement infrastructure. The groups differ in their size and the extent to which they engage in value-based contracting, though all are moving to increase the amount of financial risk they take for their quality and cost performance. Unlike hospital-employed and multispecialty groups, independent primary care groups can aim to reduce health care costs without conflicting incentives to fill hospital beds and keep specialist incomes high. Each group was positively regarded by external observers. The groups are under pressure, however, to sell to organizations that can provide capital for additional infrastructure to engage in value-based contracting, as well as provide substantial income to physicians from the sale.
  
  
  CONCLUSIONS
  Large, independent primary care groups have the potential to make primary care attractive to physicians and to improve patient care by combining human scale advantages of physician autonomy and the small practice setting with resources that are important to succeed in value-based contracting.
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York lac2021@med.cornell.edu.
authors.forename: Lawrence P
authors.initials: LP
authors.lastname: Casalino
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York.
authors.forename: Melinda A
authors.initials: MA
authors.lastname: Chen
authors.affiliation: ProHealth Physicians, Farmington, Connecticut.
authors.forename: C Todd
authors.initials: CT
authors.lastname: Staub
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Press
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York.
authors.forename: Jayme L
authors.initials: JL
authors.lastname: Mendelsohn
authors.affiliation: ProHealth Physicians, Farmington, Connecticut.
authors.forename: John T
authors.initials: JT
authors.lastname: Lynch
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York.
authors.forename: Yesenia
authors.initials: Y
authors.lastname: Miranda
mesh_terms: D001130:Arizona; D001291:Attitude of Health Personnel; D003120:Colorado; D003237:Connecticut; D006123:Group Practice / Q000458:organization & administration* / Q000592:standards; D017048:Health Care Costs; D006801:Humans; D008824:Michigan; D009820:Ohio; D058007:Physicians, Primary Care / Q000458:organization & administration / Q000523:psychology; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D017009:Professional Autonomy; D058996:Quality Improvement; D014481:United States; D062505:Value-Based Purchasing
keywords: medical groups; primary care