The national movement toward value-based, accountable healthcare focusing on outcomes rather than volume of services is one of the most significant health policy developments of the last decade. Nowhere is this more critical than in primary care. In value-based delivery models, care is provided via coordinated and multidisciplinary teams focused – and paid – to keep people healthy while better managing expensive chronic conditions. This is in contrast to the prevailing “fee-for-service” care delivery model where reactive episodic treatment of acute illnesses leads to enormous costs without better outcomes for patients.
My experience from caring for people in underserved areas of Cleveland tells me that providers need to deliver services beyond typical primary care – they need to coordinate transportation, address housing and food insecurity, and address behavioral health and social isolation issues. While primary care providers are on the front lines of treating patients with expensive chronic diseases such as heart failure, chronic obstructive pulmonary disease (COPD), diabetes, and kidney disease, a new model is emerging which tightly coordinates specialists while quarterbacking each patients’ comprehensive care plan.
Behavioral Health, Interoperability and eConsent: Meeting the Demands of CMS Final Rule Compliance
In a webinar on April 16 at 1pm ET, Aneesh Chopra will moderate a discussion with executives from DocuSign, Velatura, and behavioral health providers on eConsent, health information exchange and compliance with the CMS Final Rule on interoperability.
This common-sense approach is, unfortunately, novel within our healthcare system. For years, many patients have been unable to access specialty care in a timely manner due to financial barriers, an inability to get a ride, or because they were simply overwhelmed and didn’t know where to go for help. In one study, less than 35% of specialist referral attempts resulted in completed appointments.
Value-based, accountable care providers prioritize timely coordination to ensure teams make not only the right diagnoses, but also design the right plans to keep patients healthy. As national spending on primary care has decreased, frontline providers have less time and resources and therefore send an ever increasing number of patients to specialists which leads to fragmented care and higher overall costs. Between 2000 and 2019, the portion of beneficiaries seeing five or more physicians annually increased from 18% to 30% and the average number of specialist visits rose by 20%, according to the Centers for Medicare and Medicaid Services (CMS). Our system is encouraging more cooks in the care kitchen, rather than streamlining teams of care providers to work together for the patient’s benefit.
There is a different way, however, in which barriers to specialist access can be addressed via the integration of virtual specialist networks. On platforms like these, primary care providers electronically connect with doctors from over a hundred medical specialties, integrating their expertise into a patient’s care plan. Rather than waiting weeks or months for specialty care, patients are able to receive expert guidance in minutes. This type of harmonization leads to improved clinical outcomes, reduced hospitalizations, a more convenient patient experience, and better quality of life for patients.
Recently, I cared for a patient with a history of cardiac and substance-dependence related issues. On top of this, like many of my patients, this person came to me with a substantial dose of health system mistrust; all he wanted was a primary care provider who would treat him as a whole person. After an initial assessment and taking his medical history, I was able to send targeted questions to specialists in cardiology, endocrinology, and psychiatry. The recommendations provided were integrated into his care plan and the virtual platform saved him three separate office visits. Most critically, this process played out in hours rather than the weeks it would have taken in a traditional structure.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
There’s also an added bonus for primary care providers in this model. As any professional knows, while the expertise of colleagues are critical, it is also important for those you work with to be a good fit for the type of work you’re doing. On the virtual specialty care platform my practice utilizes, primary care providers are able to evaluate the specialists they work with. This is important because our system should encourage collaboration in support of positive health outcomes over disjointed layers of specialist upon specialist with little communication back to primary care. By enabling enduring and collegial primary care/specialty collaboration, we also bring about deeper relationships between primary care teams, specialists and patients.
As the nation’s healthcare needs continue to evolve, we must persist in our efforts to find innovative ways to meet them. The intentional use of specialty care coordination inside value-based, accountable primary care structures are necessary tools in the march to reward value and positive health outcomes over the volume of services rendered.
Photo: Dmitrii_Guzhanin, Getty Images
Laolu Fayanju, MD MSc is a family medicine physician and Ohio Regional Medical Director at Oak Street Health. He is also a member of the White House Health Equity Task Force.
