More lessons to learn on the road to value-based care

As chief medical officer of a mobile medical group serving high-risk patients, I fully agree with Dr. Marc Harrison’s recent lessons learned on the transition to value (Guest Expert column, Jan. 13, p. 23). I would add a couple more.

First, we can’t deliver value if patients can’t access care. For vulnerable patients who are both socially disadvantaged and medically complex, a care model based around brick-and-mortar delivery sites leaves too many patients without a successful and reliable source of care. Many of the patients who most need care cannot or do not reliably attend medical visits— due to physical, behavioral and social barriers. The costs associated with their detachment from the traditional delivery system are high both in terms of disease burden and dollars. Mobile providers who can reach patients “where they are” and build trust-based longitudinal relationships are needed if we are to improve outcomes and value in this part of the population.

At the same time, in order to elevate outcomes for the full high-risk, highcost population a mobile care model must be scalable. Traditional housecall practices have difficulty reaching enough patients because much of the doctor’s day is wasted in the car and few clinicians are interested in practicing in such a model.

The next generation of housecall practices must address these challenges using technology and other enablers. Our practice uses a telemedicine platform to link our primary-care doctors into homebased visits.

Interestingly, our telemedicine-enabled program is achieving similar results to those cited by Dr. Harrison—a 50%-60% reduction in hospital costs and a 38% reduction in emergency department costs—in a very high-risk population. Our findings are consistent between Medicare and Medicaid, and urban and rural populations.

Dr. Neil Solomon

Chief medical officer

MedZed Physician Services

San Francisco