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Primary care doctors can select providers and healthcare entities to create care coordination teams designed to enhance population health management.
Small practice physicians know their patients, see their patients more often and make more medical decisions about their patient’s health than any other clinician.
Still, while primary care doctors can take claims data and information from their electronic health records (EHRs) to follow their patients and deliver appropriate care, which is critical to population health management, partnering with local doctors, specialists, hospitals and other community healthcare stakeholders is the best way for private practice physicians to advance their population health strategy.
“Population health’s success is based on enhanced collaboration between healthcare stakeholders and their ability to transfer patient data at the right time and in the right format so that care teams can make the right decisions with speed,” said David Nash, MD, MBA, dean of Jefferson College of Population Health at Thomas Jefferson University in Philadelphia, Pennsylvania.
The Centers for Medicare & Medicaid Services (CMS) has set a goal of tying 50% of fee-for-service Medicare payments to quality or value through alternative payment models, such as accountable care organizations (ACOs), advanced primary care medical homes or bundled payment arrangements bundled payment arrangements by the end of 2018.
Nash said Medicare, Medicaid and other health insurers’ introduction of a global fee for a patient’s episode of care such as a knee replacement or heart surgery, has meant that doctors have a financial incentive to participate in care teams that follow evidence-based practices. Because payments are tied to the success or failure of patient outcomes doctors will need to pick their partners carefully.
Care coordination results in changing relationships
In a value-based model, where care coordination and improved patient outcomes are directly tied to their incomes, primary care physicians will have a different relationships with other care providers, such as specialists.
The modern incarnation of population health means that specialists are also part of the team led by the primary care doctor taking care of the patients, Nash told Medical Economics. He added that in today’s model of care, small practice physicians can be more discerning as to which specialists they send their patient to. They can also leverage their influence by selecting which cardiologist, gastroenterologist, urologist or other specialist in the network will get the referral based on the best available evidence.
In fact, primary care physicians will be the driving force behind designing care coordination across the whole spectrum of care delivered, including the office, hospital, rehab centers, nursing homes and palliative care centers.
In this scenario, they’ll be some winners and some losers, Nash said. In the past, primary care physicians didn’t have an economic incentive to evaluate all 10 rehabilitation centers a patient with knee surgery was sent to after being discharged from hospital. However, in a care coordination world based on performance, physicians are looking for those rehab centers that provide excellent outcomes, and out of 10 there may only be two that doctors want to do business with.
As primary care doctors seek to improve patient outcomes, they’ll want to know who is going to be a non-profligate tester, and who is going to return the patient to them in a timely way with a high level of patient satisfaction.
“It’s this level of accountability that will deliver a higher quality of care at a lower cost for a larger number of patients,” Nash said.