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