I've been meeting with physicians nationwide about their planned, ongoing and potential transitions from fee-for-service to value-based reimbursement. It's certainly a work in progress.
While we have a ways to go, the value-based care model—combining the practice of population medicine with innovative payment models—has already resulted in better health, improved quality and lower costs for patients, providers and health plans.
Value is why physicians went to medical school and why many of us want to get up in the morning and help people. It focuses our energies on making people healthier while improving quality of life. Yet healthcare providers have concerns that still need to be addressed during this transition. Here are some questions I've been asked frequently and how I've responded.
How can health plans help us improve population health, given pressure to reduce costs? Cost reduction should never be achieved at the expense of high-quality care and improved health. When healthy people spend less time in the hospital, health plans experience lower costs because members are spending less time in the hospital. The healthier people become, the more physicians are reimbursed.
How do you respond to physicians who don't want to be told by health plans what to do when it comes to patient care? In fee-for-service, the sentiment by clinicians that health plans are at odds with them was/is widespread. Interestingly in the “value” world, I almost never hear this concern because of the clinician/insurer alignment. The data, analytics, care assistance and contracting are all things that help the clinicians take better care of the physician's patient population and increase the profitability of the practice/system.
How does the value-based approach enable me to spend more time with my unhealthiest patients? In population medicine, a physician spends more time with each patient (about 30 minutes) as opposed to the typical 12 minutes. When physicians spend quality time with fewer patients, the focus of these prolonged interactions is wellness and prevention.
What improvements can be made to the preauthorization process to minimize unnecessary hurdles? Progress is ongoing. For example, my company reduced administrative burdens by replacing time-consuming fax oncology approvals (15–20 minutes) with a web-based portal (4 minutes) that also resulted in improved safety and better reimbursements.
I'm dealing with multiple insurers, all with multiple quality measures. What can be done to simplify this? For the first time, every major health plan and the CMS have agreed to a core set of quality health metrics. Greater consensus is needed to reduce metric complexity and anxiety. At Humana, we reduced the number of required quality metrics by identifying and eliminating redundancies, duplications and inconsistencies.
I manage a small practice. My nurses and medical assistants are stretched thin, and my patient population is growing. How can moving to value-based help? Moving to population health without planning and technical assistance can be challenging to a practice. We work with practices to ensure this transition is advantageous to the physicians from both a quality and economic standpoint. When done correctly, this transition usually takes a number of years.
In a value-based system, I'm responsible for patient outcomes. How can I be responsible when some patients don't follow my recommendations? You're correct; you are responsible for their outcomes. That's why partnering with other entities is so important. The clinician needs to know if their attributed patient is being seen by someone else, has moved or is taking the prescribed medicines. To be successful in the value-based world, working with other providers—true coordination—is essential.
All of us—physicians, nurses, hospitals and other caregivers, and especially patients—are stakeholders in the value-based reimbursement movement. Providers must have complete alignment with how we all care for patients and focus on promoting their best health. Value requires interoperability, data analytics, and improved care inside and outside the traditional physician office and hospital—taking advantage of home health services and wearable technologies. With combined efforts, patients should receive better-quality care, clinicians should have healthier patients, and the healthcare system should spend less money.
