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October 10, 2020 12:00 AM

Letters: Maybe dropping out of ACOs is a good thing for patients

Modern Healthcare
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    Circa 2018, Humana said it found that when different parties used terms such as value-based care, they didn’t mean the same thing. They convened a panel of experts to develop consensus definitions for the terms value-based payment, value-based care and population health. The expert panel was unable to arrive at a consensus definition for value-based care or population health.

    In his recent editorial “Value-based care now at risk,” Merrill Goozner assumes that the CMS-sponsored ACO is an “experiment in value-based care.” But it is unclear what definition he is using for “value-based care.” Since there is no requirement for patients to use in-network providers, it is impossible to control optimal care delivery or outcomes, which are hallmarks of all definitions of value-based delivery systems.

    Maybe providers want to divert their time from this failed government experiment and put more time into direct patient care. Now that’s value-based care if you ask me.

    Nathan Kaufman
    Managing director
    Kaufman Strategic Advisors
    San Diego

    Women physicians might be leading the way to value-based care

    The article “Women primary-care docs spend more time with patients, generate less revenue” is an unfortunate rear-facing view of primary care. As an administrator of primary-care clinics in Los Angeles, this gives me hope that women doctors in primary care are, perhaps unknowingly, preparing themselves to be more successful than their male counterparts.

    The shift in primary care that focuses on team-based and value-based care of populations lends itself to increasing the value of primary-care visits, incorporating social determinants of health, health education, behavior modification and other forms of life-stabilization strategies. In California, there is a strong penetration of capitated HMO plans in the marketplace that reward primary-care practices for patient wellness, lower utilization of high-cost services, and better management of health maintenance. Many primary-care practices are thriving in this model.

    The primary-care transformation is happening in other places like the University of Utah’s Care by Design model and the University of Colorado’s APEX model as discussed in an article titled “A team-based care model that improves job satisfaction” in the March-April 2018 issue of the American Academy of Family Physicians’ FPM journal. In these and other similar models, rather than the patients only seeking care when they are sick or injured, practices are becoming a place where patients can communicate more regularly with their primary-care team, and the most appropriate person on the primary-care team (often not the physician) is made responsible for responding to the patient’s concern or question.

    The objective is for a primary-care practice to have a healthier patient population overall so the primary-care physician will be able to dedicate more time to those patients who really need the time with the physician, for which this article indicates women are better-suited.

    In my opinion, the most unfortunate reality of the U.S. healthcare system is the fee-for-service model that values revenue generation (volume) over health outcomes (value). As the shift to value and prioritization of well care over sick care advances, perhaps women physicians are leading the way.

    Chad Vargas
    Chief operating officer
    QueensCare Health Centers
    Los Angeles

    Recent editorial took the low road

    Regarding the Sept. 21 editorial “Endless lying affects us all,” as a longtime subscriber and reader, it has been obvious on which side of the political fence Merrill Goozner has been, but his opinion in this column does not heed the advice of former first lady Michelle Obama and goes really low. I do not recall him opining about “if you like your doctor, you’ll be able to keep your doctor; if you like your health plan, you’ll be able to keep your health plan” and so many others in the same language.

    It is unhealthy to express this degree of loathing for any president.

    Dr. Bhagwan Satiani
    Columbus, Ohio

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