Tom Sullivan | September 23, 2020
Competing in a value-based world can be daunting for many primary care practices. Often, the organizations do not have requisite basics, such as expertise, data and technology infrastructure.
“Does the COVID revolution and associated technology adoption that’s happened recently allow for a new vehicle for value based payment or for an engagement with patients, whether it’s a virtual medical home that happens in a patient’s home with the assumption being that the care happens there [like Amazon] and only if you need a Saks Fifth Avenue-level of service do you actually go to a clinic?” asked Rebekah Gee, MD, CEO of Health Care Services for LSU Health, and a Forum Senior Fellow.
To address that, as well as pre- and post-pandemic issues, the Health Evolution Forum, consisting of nearly 200 provider, payer and life sciences CEOs, has preliminarily identified the following areas of focus that are critical to advancing new models of care delivery:
Areas of primary care ready to be reimagined
This piece, the second in a three-part series, examines reinventing primary care and companion articles delve into value-based payments and advancing home-based chronic care models. Here is part one of this series.
Gee continued that trying to force functions, such as reducing or eliminating no-shows, will not work to maintain or increase revenue or improve patient outcomes.
“So the next question is what can we reimagine?” Gee added.
The Health Evolution Forum preliminary survey, in fact, found that the following areas of primary care redesign hold the most promise:
Now that the overwhelming majority of providers have made large investments into EHR platforms, Gee explained that many CEOs and other executives need a new way of thinking about how to manage digital information, notably the content of a clinical visit because improving primacy care is difficult without that data.
“What’s happening is a growing realization, especially with COVID, that the ability to collect first-dollar-premium is not limited just to the insurer or just to primary care, but actually the subspecialist groups as well,” said Gaurov Dayal, MD, President, New Markets and Chief Growth Officer, ChenMed, and a Forum Fellow. “We‘re seeing examples of this across multiple segments of the physician space. It’s a favorable thing as long as it leads to better care, not to inappropriate reduction of care, just to save a buck, which of course could be an unintended consequence.”
Lee Sacks, MD, former CMO, Advocate Aurora Health, and a Forum Senior Fellow, added that the opportunities are boundless when it comes to reinventing primary care.
“There should be ready access and the choices will be made by the consumers of care to have a smooth continuum when they deal with chronic conditions or need more relational based higher–acuity care,” said Penny Wheeler, MD, CEO, Allina Health. “We should potentially be thinking about an attachment strategy for lower acuity services — retail or virtual — in primary care. Lower acuity care will likely become more commoditized while whole complex, chronic care will continue to be more relationship centered.”
While CEOs consider the wave of consolidation and mergers and acquisitions, primary care practices are hot commodities on the market right now under the right circumstances.
“The fact that consolidation continues at a very rapid pace is not a good or a bad thing, but if you look at it from a lens of value creation, there are two things,” Dayal said. “One is unit reduction or appropriate utilization of services. And the other is unit cost. The challenge we’re facing is that utilization metrics actually don’t show rampant out of control increases. They’re stabilizing in many instances decreasing, but unit cost continues to accelerate. And if that’s the case, any value-based initiative, is always going to keep hitting a stone wall.”
During August, the Health Evolution Forum ratified Work Groups to address each of the three critical action areas outlined above. CEOs and other participants will identify best practices already being used successfully in the industry and then disseminate them across the industry.
Forum Fellows and leaders, in turn, are committed to both employing those practices and advocating that their peers do as well.
“Most of us who are physicians have no idea how to manage a value–based patient,” Dayal said. “It isn’t the same thing as a fee-for-service service treadmill.”