Are we col­lec­tively ready to sup­port physicians’ jour­ney to value-based care?

Modern Healthcare - - COMMENT - By Dr. Wanda Filer and Dr. Roy Bev­eridge

In 2014, the U.S. spent more than $3 tril­lion on health­care. The time to adopt a pa­tient-cen­tered, value-based sys­tem and break free from the bro­ken fee-for-ser­vice model is now.

The good news is that we’re al­ready see­ing health sys­tems join with health plans across the coun­try in ac­count­able care part­ner­ships, be­gin­ning the shift to value.

But are physicians in gen­eral ready to re­ceive pay­ments based on value? Are the CMS and health plans ready to be will­ing and trusted part­ners with physicians to im­prove the qual­ity of care pro­vided? With HHS’ plan to tie half of all tra­di­tional or fee-for-ser­vice Medi­care pay­ments to value-based pay­ment mod­els by 2018, time is short for physi­cian groups to make the jour­ney away from fee-for-ser­vice.

Con­sid­er­ing the ur­gency of this trans­for­ma­tion, the Amer­i­can Academy of Fam­ily Physicians polled more than 600 fam­ily physicians on be­half of Hu­mana to an­swer one ba­sic ques­tion: Are physicians ready? What we learned from polling those doc­tors on their per­ceived progress to­ward val­ue­based pay­ment is that we now need a bet­ter ques­tion: Are all health­care stake­hold­ers—in­clud­ing hos­pi­tal sys­tems, elec­tronic health-record ven­dors, health plans and spe­cial­ists— ready to sup­port them?

Physicians in the wait­ing room

Physicians are mak­ing progress. The poll found that 1 in 3 are al­ready ac­tively pur­su­ing value-based pay­ment. Lack of time to im­ple­ment that change was cited by physicians as one of the largest ob­sta­cles to adopt­ing value-based pay­ment.

Based on the ex­pe­ri­ence of health­care providers, it’s no se­cret that physicians are con­cerned they won’t have the time or re­sources needed to suc­ceed un­der value-based pay­ment. So, al­though they are un­der pres­sure, many are not yet pre­pared to suc­cess­fully make the tran­si­tion.

We can­not lose sight of the fact that this is a his­toric en­deavor, up­end­ing decades of med­i­cal prac­tice and the health­care fi­nanc­ing sys­tem. Physicians are al­ready shoul­der­ing an enor­mous bur­den with the im­ple­men­ta­tion of EHRs and a grow­ing num­ber of ad­min­is­tra­tive tasks that take time away from their pa­tients. It can be over­whelm­ing to take the first step to­ward value.

Tak­ing the first step

This is an op­por­tu­nity to clear the way for physicians mi­grat­ing to­ward value. While in­vest­ment in pop­u­la­tion healthman­age­ment tech­nolo­gies can help, and is an area where physicians need sup­port, tech­nol­ogy alone will not solve our chal­lenge. Value-based pay­ment part­ners need to lis­ten to physicians, and iden­tify where sup­port can com­ple­ment their prac­tices to cre­ate time for qual­ity care, not more work or dis­trac­tion from the ul­ti­mate goals: im­prov­ing pa­tient health, low­er­ing cost and cre­at­ing a bet­ter pa­tient ex­pe­ri­ence.

How­ever, good in­ten­tions can also cre­ate com­pli­ca­tions. Con­sid­er­ing that most fam­ily physicians are work­ing with sev­eral dif­fer­ent in­sur­ers, health plans must pro­vide well-co­or­di­nated sup­port de­signed around the physi­cian group’s busi­ness model and work­flows. It can­not be a one-strat­egy-fits-all ap­proach, and suc­cess re­lies on the full en­gage­ment and col­lab­o­ra­tion of ev­ery­one in­volved.

A holis­tic ap­proach with re­sults

We be­lieve that sup­port for pri­ma­rycare physicians comes in the form of per­son­al­ized care co­or­di­na­tors and health coaches who max­i­mize pa­tient en­gage­ment and help physicians close gaps in care. It in­volves pe­ri­odic up­dates us­ing real-time data from th­ese co­or­di­na­tors/coaches, via an EHR, about any bar­ri­ers to pa­tient ad­her­ence, any ac­tions taken and re­sources pro­vided by the co­or­di­na­tors to im­prove the pa­tient’s health.

Health plans must also con­tinue to ex­pand be­yond care co­or­di­na­tion to ad­dress the 10,000 peo­ple a day who age into Medi­care, so that peo­ple can re­main in­de­pen­dent and stay in their homes. This also in­cludes co­or­di­nat­ing trans­porta­tion for Medi­care mem­bers to visit their pri­mary-care physicians and us­ing re­mote mon­i­tor­ing devices to re­duce the risk of falls.

It is our shared re­spon­si­bil­ity as health­care stake­hold­ers to cham­pion the suc­cess sto­ries we see in value-based care to­day. At Hu­mana, over 1 mil­lion Medi­care Ad­van­tage mem­bers are be­ing treated by physicians through val­ue­based re­im­burse­ments. Mem­bers in th­ese pro­grams of­ten ex­pe­ri­ence fewer emer­gency room vis­its and fewer in­pa­tient ad­mis­sions than those seen by physicians in stan­dard Medi­care Ad­van­tage ar­range­ments.

Th­ese im­prove­ments aren’t pos­si­ble with­out a com­mit­ment from physicians and health plans to make value-based pay­ment a suc­cess. The health­care in­dus­try will progress only if we leave the past be­hind and work to­gether to build a health­ier, more sus­tain­able fu­ture. It’s a fu­ture that our pa­tients and mem­bers de­serve.

Dr. Wanda Filer is pres­i­dent of the Amer­i­can Academy of Fam­ily Physicians, and Dr. Roy Bev­eridge is chief med­i­cal of­fi­cer at Hu­mana.

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