At IKP Family Medicine, a 10-provider practice in northwest Houston, the sudden, forced switch to video visits amid the COVID-19 pandemic could have been a disaster, as some patients are in their 80s and 90s and still use flip phones.
Fortunately, IKP has been reimbursed in part through capitated models for at least 16 years, so its doctors are used to treating patients however it makes sense for them, without worrying about how they’ll get paid. When a 92-year-old patient recently needed a medication refill but was terrified to come in for fear of getting COVID, for example, Dr. Timothy Irvine simply called her to sort it out.
“With a capitated model, you’re trying to take care of the patient the best way you can,” said Irvine, who founded the practice with two other physicians. “You don’t have these financial hurdles you have to get across to take care of the patient.”
Not only that, it was a dependable revenue stream even when patient visits plummeted, he said.
The pandemic has laid bare the vulnerability and waste associated with the traditional fee-for-service model, which is how most primary-care physicians are still paid, and has underscored the benefits of the increasingly enticing world of value-based care, wherein doctors receive set payments for managing patients’ health and have more flexibility in how they do that.
But experts caution this isn’t the sort of arrangement a practice can go into on a whim. There are logistical hurdles, state and federal regulations, existing insurance contracts and cultural issues to consider.
“In theory it sounds so simple, and it’s extremely complicated,” said Tracy Watrous, vice president of the Medical Group Management Association.