Washington, D.C. — Fill a room with physicians and they'll tell you what's wrong with healthcare. Fill a room with executives from leading physician groups and they'll tell you how to fix it.

Those two messages were both part of the animated dialog at “The New Medical Group Paradigm: The Patient Centered Medical Home,” a concurrent session at the HCap Conference in December in Washington, D.C.

“The practice model that we have been shoe-holed into has not worked for patients, and it certainly has not worked for physicians,” said Lori Heim, MD, CMO, Scotland Memorial Hospital. “Primary care physicians want to work within a different primary care model.”

Until the Affordable Care Act came along, few people had a clear vision of what that model was, Dr. Heim said. “The greatest aspect of the reform debate is that it has thrust the topic into the forefront of attention. Now everyone knows or has heard what's wrong with the system.”

Scott Conard, MD, CMO, ACAP Health, said he has known for a long time what's wrong with the system. Insurance companies, whose agenda is “driven by how much is spent in healthcare,” have been given too much influence over healthcare policy. It's what Conard believes has led to a system where 30% to 50% of healthcare expenditures are “non value-added waste.”

The alternative that Conard's company promotes is a model where physician groups partner directly with large corporations and local governments (brokered by companies like ACAP) to deliver a patient-centric, affordable program that essentially cuts large managed care organizations out of the picture.

“The key is for physicians to get out of their heads and into the game, and start to deliver a product that corporations would actually want to purchase, and would be able to purchase, in a way that would make a difference to their healthcare spend,” Conrad said.

One such program on the West side of Chicago is run by Michael Kasper, CEO of DuPage Medical Group. DuPage, which consists of 350 doctors (half primary, half specialty) has become the poster child for physician group success. With annual revenues in the range of $400 million, and a base of more than 3,000 total employees, DuPage does everything “except run hospitals,” Kasper said.

A key component to the DuPage success story so far has been data.

True to the accountable care model, research and information gathering have been the lynchpin to helping the group create a place for itself in the market. To this end, DuPage has created an internal strategic business unit called the Value-Driven Healthcare Group, which works with Epic, the company that manages its medical records, to extract information out of its system and “arm physicians with information at the point of service to really treat the patient differently.”

DuPage also analyzes normative data about other providers in the market, and recently teamed with Boston-based Humedica, a company that benchmarks provider performance against a national database, as well as Phytel, a Dallas-based company that facilitates patient outreach online and over the phone. “That's just the tip of the iceberg of what the data needs of this type of program are going to be,” Kasper said.

But data alone is not the answer. The creation of a differentiated, patient-centric, “value-based” system, driven by physicians is not for everyone, and can’t work everywhere, Kasper admits.

“This is a fundamental shift in healthcare, and it's going to be hard work. There's no silver bullet to fix this,” he conceded. “We have to start thinking about how we spend resources in the system and make sure they're focused on the populations where we can have the biggest impact.”