Most independent practices sign the payer contract they are handed. One or two doctors alone are not on a health plan's radar, so the rate stays low and the practice works harder to make up the difference. This week Dr. Heather Signorelli sits down with Ben Phillips, CEO of Nivano Physicians, an independent physician association in Northern California, and host of Healthcare Uncut. Together they break down how small practices build the leverage the big systems already have. ACOs vs IPAs. ACOs are built to lower the total cost of care, and physicians share in the savings, usually paid the following year. IPAs bring independent doctors together to negotiate managed care contracts as one group, often on a capitated, delegated model. No IPA in your area? Throw a pizza party. Ben's advice is literal: invite the independent doctors in your community, across specialties, to dinner and ask whether everyone is struggling with the same rates. That conversation is how an IPA starts. How to judge an IPA. Look at it like any business you would join: its contracts, its stars rating, whether physicians have a real voice, and whether you are a shareholder or just a member. Brand is leverage. The bigger institution gets better rates because of the patients it brings. A practice that grows its patient base and shows a health plan where it saves money earns a stronger seat at the table. THE IPA INTERVIEW: QUESTIONS TO ASK BEFORE YOU JOIN • Contracts: Which payers do you hold, long-standing plans or startups? What are the rates? • Quality: How many stars do you have? How do you track HEDIS? • Patients: Can patients get in on time, get follow-up care and a call on lab results? • Voice: Is my voice as a physician expected, encouraged or dismissed? • Ownership: Am I a shareholder or just a member? • Network: Which hospitals and surgery centers do you partner with? • Community: Are local doctors of every specialty represented? THREE ACTIONS THIS WEEK • Pull your current commercial rates and compare them to Medicare for your top codes • Ask the independent doctors near you whether they belong to an IPA, and which one • Score your billing on six numbers before your next payer conversation