New reimbursement models can drive investment in primary care-and counter physician burnout
Physician burnout is a problem that has many causes-excessive documentation and technology headaches chief among them-but a recent Medical Economics physician survey included a less-scrutinized source: Patient needs that sometimes overwhelm their doctors.
Through my own experiences and conversations with colleagues, I’ve come to believe that one of the chief reasons primary care physicians feel overwhelmed by patient needs is that too many still practice under the fee-for-service model. As both a workflow and financial model, it simply does not support the effort required to manage complex cases nor is it conducive to strengthening the physician-patient relationship.
That the U.S. health system is finally realizing its long-overdue opportunity to overcome the limits of fee-for-service is one of the most encouraging trends in medicine today. To replace this outmoded model that has failed too many physicians, more practices are transitioning to value-based contracting arrangements in which providers are rewarded for quality over volume.
However, the challenge that many primary care providers face in shifting to value-based care is that their practices are often not equipped with the tools needed to succeed under value-based models. It is a preventive, multidisciplinary approach to care that places a premium on care coordination. In turn, this requires technology that stratifies and prioritizes care opportunities for at-risk populations and helps providers maximize incentives tied to performance-based contracts.
New practice models for primary care
The lack of necessary tools may be changing, though, in part due to the new federal program called CMS Primary Cares. The program offers five financial models, including one based on risk-adjusted per-member, per-month payment. This arrangement in particular will deliver greater financial certainty to practices, providing the funds to invest more heavily in tools that support the delivery of advanced primary care.
Importantly, upfront payments for each patient is a significant and predictable revenue source. By investing a portion of these upfront payments in new tools to help their practices manage populations based on risk and urgent needs, primary care providers can set themselves on a path to success in the shift to value-based care.
It should be understood that transitioning to value-based care won’t be an easy shift. To achieve true transformation, practices will require not only new financial models, but new technology, new workflows, additional staff training and lots of support.
Value-based care gaining traction in Arizona
As chief medical officer at Phoenix-based integrated delivery system Equality Health, I am part of a team that provides tools to our primary care provider network to aid the delivery of proactive, value-based care. The provider practices in our network receive specialized training that assists them in assessing patients for behavioral, social and cultural risk factors that could hinder even the most carefully designed care-coordination plans.
As a result of our health system’s significant Latino patient population, for example, our curriculum for providers emphasizes the incorporation of values and cultural beliefs that have significant meaning to this population.
We also know firsthand that our providers need real-time visibility of at-risk patients. We’ve developed a proprietary care coordination response that delivers this insight at micro and population-sized levels. At the micro-level, for example, physicians can identify care gaps for individual patients, while also having access to macro-level information such as our overall population health management performance for various conditions.
These insights are fueled by a diverse and consolidated set of data sources in our care coordination platform. It is this aggregated and structured set of data that provide a comprehensive view of patient health that expedites risk stratification, enabling physicians and staff to assemble and review lists of patients-by condition or gap-who are due to obtain specific services. To improve outcomes, it is critical to track at-risk patients and coordinate their care among all key stakeholders.
It is also crucial for primary care providers to receive real-time alerts for important care events such as admission, discharge and transfer. These alerts inform prompt follow-up, which is key to reducing readmissions. As such, this is a feature we embedded early on in our care coordination platform.
Our frontline position helps us see with our own eyes how unified collaboration and a full picture of patient health are integral to value-based care. Primary care providers see it, too, and collectively are using the platform to deliver risk-based care within five Medicaid health plans in the state. Thousands more clinical sites across the country have also deployed the platform.
It’s critical that all primary care practices have this kind of support, and the new Primary Cares reimbursement model can help them pay for it.
Of course, reimbursement reform won’t solve every problem in healthcare. But payment reform is a move in the right direction. By transitioning to new financial models that reward value and quality of care as opposed to volume, primary care practices can escape the fee-for-service hamster wheel and practice medicine in a way that prioritizes the doctor-patient relationship.
Mark Stephan, MD, is a physician leader who practiced family medicine for 19 years. He is currently chief medical officer at Equality Health, a Phoenix-based integrated delivery system that delivers care through a social-cultural lens.