Dr. Angele Seiler of Arlington Primary Care asked the question: What does it takes for independent physicians to thrive under new value-based insurance payment models, such as the Patient-Centered Medical Home (PCMH)? The verdict: A new approach, the right technology, and expert team support.
“In three or four years there will be no more fee-for-service. All physicians will be entered into risk-based contracts and be responsible for the total cost of care,” said Scott Disch, VP of Performance at Privia Medical Group, to a gathering of physicians from across the DC region on Thursday night in Arlington. As an example, Disch cited some Medicare Advantage plans that will assign a provider 200 patients and pay that provider $20 per member, per month. “That check comes in every month, no matter what the doctor does and you’re performing against the overall network.” If the doctor keeps those 200 patients healthy each month, for less than the $40,000, he or she keeps the profit. If not, however, the doctor bears those additional costs.
Succeeding in these soon-to-be ubiquitous arrangements, requires technology and support teams to identify the sickest and highest costs patients, engage those patients to execute a care plan, and ensure that all care is provided by high quality, cost-effective providers.
“If the payers are changing, if the government is changing,” Disch asked, “how do we change our practice?”
Dr. Seiler, who also was in attendance, noted how her practice’s partnership with Privia Medical Group is helping her adapt to these new payment models. First, Privia provides necessary resources. “Some physicians have RNs, our practice does not but Privia has a nurse intensivist, a nurse educator, social workers, a pharmacist, and we interact really well,” Seiler said. “The population health strategy means we have all the support staff that our practice could never afford on our own.” Most importantly, Seiler says, “this improves patient care.”
Next, Privia’s fully integrated EHR and technology puts important information directly into her workflow. Seiler talked about how Privia’s technology provides her cost and quality data right inside athenaHealth, the EHR solution that Privia provides all its practices. “Now I know which hospitals are high cost and which are low cost, and when I refer my patients, if certain specialists admit to the high cost hospital, I can now see that and instead refer to specialists who are just as high quality and admit to low cost hospitals.” Disch added that Privia’s technology can pull information from claims data, demographic data, the medical record, other specialists or labs, and quality requirements and present the provider with the right piece of information, about the right patient, and in the right place in the provider’s workflow.
Finally, Dr. Seiler and Scott Disch focused on the need for expertise. Population health is not really possible to do on your own at a small to medium-sized practice. To be successful in such arrangements, physicians must adopt team-based care strategies and deploy technology data-driven tools and processes to identify and engage their sickest patients. “This is too hard and too expensive to do on your own. You’ve got to pick a partner,” Disch says. “But if you don’t, your ability to get compensated is at risk. Privia puts a team alongside you to help do this work, help maximize your workflows and efficiency in the EMR.”
It’s no secret that the shift from volume to value in health care payments is driven by the need of both government and private payers to spend less on healthcare in America. These new models push a large amount of risk onto the provider – especially independent physicians in small and medium-sized practices. But with that risk comes the opportunity for great financial and clinical reward for those independent physicians who can find the right team-based approaches, paired with the right technology tools.