Last year Healthcare Innovation interviewed Matt Eakins, M.D., CEO of Atria Health, which offers a partnership approach that helps independent cardiology practices thrive and maintain their autonomy as they transition to value-based care. Originally, the company partnered with AMS Cardiology in Pennsylvania. Now Atria is working with Memphis-based Stern Cardiovascular, which is one of the largest cardiology practices in the country, providing care across Tennessee, Mississippi, Arkansas and surrounding regions. 

Stern recently ended a 14-year arrangement with Memphis-based Baptist Hospital and sought a partner other than traditional private equity arrangements to help it with expansion and infrastructure. 

Healthcare Innovation recently spoke with Eakins, who was joined by Stern Cardiovascular CEO Debbie Eddlestone and cardiologist and President Steven Gubin, M.D.

Healthcare Innovation: Dr. Gubin, could you give us some background about Stern and why the partnership with Atria looked promising? 

Gubin: We had been primarily affiliated with Baptist Hospital. I always say that we dated for 90 plus years, then we got married for 14, and now we're separated, but the separation is a positive one. We still have a good relationship with the hospital, and we've grown. I was number 10 in the group, and now we have 46 cardiologists and over 500 employees.

It was never that we had a bad relationship with the hospital, but everybody in this group has been very motivated to grow and bring the best technology possible to the Mid-South, and we felt a little bit handcuffed in the hospital, because we weren't the only group in the hospital. They have resources, but they have to take care of all their different groups. 

We looked around and we didn't want to do traditional private equity. We were looking for something else, and we came across Matt Eakins and Atria, and we were very intrigued by the model. They said we could continue to do what  we’ve done well for the last 106 years but they can help us get technologies and new services that we don't have. That's what we liked. We knew that PET CT was getting big in cardiology, but it was very expensive. We knew that most things in cardiology were going outpatient, and Atria said that they would provide us with the resources to get an outpatient cath lab and maybe intensive cardiac rehab and also PET CT. 

We also know that around 85% of cardiologists are employed by hospitals, and a lot of the cardiologists aren't happy. We were probably one of the first groups that was employed to break away from a hospital and become independent, and we think that Atria has a good model for that, and we'd like to spread the word. We've been doing this since January 1 and it's been very positive. 

HCI: Matt, when I interview you last February, one of the things you said then was that your focus was on creating new value-based service lines together with the partners. Can you talk a little bit about that approach? And it sounded like some of the things that Dr. Gubin just talked about, like introducing cardiac PET CT imaging and maybe new ambulatory surgery centers. But are there other things that you can work on together in partnership with these independent practices?

Eakins: Fostering the independence of cardiology is kind of value-based in itself, in that it's moving clinicians back to community-based practice, where the costs are almost definitionally lower and therefore more sustainable than in hospital employment. That is also consistent with moving these procedures, like nuclear imaging and PET CT, into the community, as well as the ambulatory surgery centers. This is all coming together, and we are also partnering very closely with the health plans that are critical in the Mid-South to advance cardiovascular value-based care initiatives. They are going to support us around heart failure programs and continuing the great tradition that Stern has in leading on metrics for readmission, for instance.

HCI: You worked with AMS Cardiology initially to refine this model. Are there some things that you learned through that initial partnership that worked well that you're putting in practice now with Stern?

Eakins: Yes. We thought that empowering physicians in the practice would be valuable. It's harder, but it creates a lot of value in the long term. We saw that come to fruition at AMS and starting early now with Stern. The other thing we did is, as we built those service lines that we were discussing, we also own the capability ourselves and build the muscle within Atria. So a number of the learnings that perhaps forced us to go a little bit slower than we had wanted to with AMS, we expect not to repeat those mistakes again and instead go quite fast and create a lot of value with Stern in Memphis and beyond.

HCI: Debbie, this is a slightly unusual business model arrangement that is not the typical private equity deal. Was that challenging to you to explain to the employees in the practice in terms of how this was going to work?

Eddlestone: It was and it still is hard to explain, because, there's been so much private equity in all the other specialties. For Stern, we always were very honest with our staff in telling them we were looking for a partner that has a shared vision, that has a shared goal with us. We wanted to be able to offer advanced technologies and stay on the cutting edge. When we talked to Matt and Atria, it just was very synergistic. We have a very good internal administrative structure, and even under Baptist we were physician-led. So this was just the perfect mix. As we gain back our independence, we kept our internal structure, and that's how we kept our employees calm about the whole transition.

We’ve been with Atria for almost three months now, and the employees understand it's not truly the private equity model.

Gubin: We had 46 physicians that really worked hard, and we wanted every single person to join in this platform. And I'm really proud to say all 46 doctors joined.

I think there are a lot of other cardiologists in the country now who are trying to do what we did but they don't know how. They don't want to be in private equity and totally controlled. We’re doing everything in the world to tell other cardiologists about what we're doing working with Atria. We're trying to recruit other cardiology groups under this platform.

HCI: Matt, are you having conversations with other cardiology practices that are in similar positions?

Eakins: Yes, we're having them with practices all across the country. And there are some tailwinds driving this. First and foremost, there is a tremendous need for cardiovascular services and lack of access for a lot of patients. Doctors within a hospital system have trouble delivering services in the community and close to patients. So that's one. Two is that there has been an increase in the ability to deliver these cardiovascular procedures in the ambulatory setting and in the community. A lot of this was discovered during the emergency measures with the COVID pandemic, when a lot of these procedures had to be done in that setting, and the people who were performing them and the folks who were studying them found them to be just as safe and efficacious, and now they can do them in the community. This ties to the third part, which is that there is so much cost pressure on the healthcare system overall. Cardiology care is going to be expensive unless we find ways to deliver that exceptional care at the lower-cost sites. So I think those three forces coming together now make it almost an ideal time for cardiologists to think about independence again.