Consumer-driven healthcare a reason to redesign practice

October 4, 2007

"Consumer-driven healthcare, to the extent that it happens, is one more reason to redesign your practice," warns Bruce Bagley, MD, American Academy of Family Physicians (AAFP) medical director for Quality Improvement, during the AAFP 2007 Scientific Assembly in Chicago on Thursday. He also noted that only approximately 5% of the insured population nationwide has actually signed up for one of the low premium, high deductible plans.

"Consumer-driven healthcare, to the extent that it happens, is one more reason to redesignyour practice," warns Bruce Bagley, MD, American Academy of Family Physicians (AAFP) medical directorfor Quality Improvement, during the AAFP 2007 Scientific Assembly in Chicago on Thursday. He alsonoted that only approximately 5% of the insured population nationwide has actually signed up for oneof the low premium, high deductible plans.

"There has been a lot more talk about consumer-driven healthcare than there have beensign-ups," he said. "It is not exactly taking the nation by storm."

But low adoption does not mean that family physicians can ignore consumer-driven healthcare.The concept is being actively promoted by government officials, as well as payers. It fits into theactivist role that the Department of Health and Human Services has assumed in recent years, Dr Bagleysaid.

Secretary Michael Leavitt has built health care policy on four cornerstones: performance measures,health information technology, transparency, and payment reform. All four areas impactconsumer-directed healthcare.

"Medicare has already been transformed from a relatively passive payer to an aggressive buyer ofhealthcare," he said. The private sector is following a similar path.

Consumer-driven healthcare relies on performance measures and health information technology tomeasure and quantify the quality of care as well as the cost of care, he continued. Quality and costmeasures are expected to be available to the public, and consumers are expected to use this newinformation as the basis to select providers and treatments.

The reality, Dr Bagley said, is likely to be different. A few consumers will go it alone, hepredicted, but most will turn to family physicians to help the navigate the confusing menu ofprovider, facility, and treatment choices.

Consumer-driven healthcare is also having a direct effect on the business side of office practice.Consumers with these plans have annual deductibles ranging from $1,000 per person to $10,000 perfamily, he said. Plans also have an enormous range of coverage options, inclusions, and exclusions."Consumer-driven healthcare requires real-time claims adjudication for billing," he said. "That isthe only way to make these programs work. If you don't have an office system that can handle theseadjudication transactions, you are not going to be able to treat these patients."

AAFP is already working to help physicians adapt to the new business reality, Dr Bagley said.TransforMED, an $8 million research and development project, is refitting 18 to 20 family practicesusing AAFP's new Medical Home model. A matched cohort of practices is making similar adjustments."The one barrier is that most of us lack a professional approach to our finances, our practicemanagement, and the management of our clinical quality. We have a seat-of-the-pants approach and thatis not working."

Dr Bagley also praised METRIC, an online quality assessment and improvement program that offers 20CME units, but with a twist. To receive CME credit, physicians must demonstrate that they haveactually changed the way they practice. A recent survey found that more than 90% of AAFP memberrespondents have made at least one permanent change in the way they practice as a result of theprogram.

"This is the new style of CME," Dr Bagley said. "We want to see results."