Dr. Christopher Crow is out to prove that primary-care practices can thrive under value-based payment. Catalyst Health Network launched in 2015 to bring together physicians in north Texas. The primary-care network has since expanded across the state and now boasts nearly 900 physician practices and more than 1 million covered lives. Crow, who serves as Catalyst’s president, says the model works because it puts an emphasis on the patient-provider relationship. The COVID-19 outbreak has exacerbated cracks in the fee-for-service model, he said. Crow spoke with Modern Healthcare Managing Editor Matthew Weinstock. The following is an edited transcript.
MH: The expansion you started last year seems to be going pretty well.
Crow: It’s changing fast. We had over 500 physicians in the last month wanting to join. Right now we’re up over 800 primary-care practices across the state.
We only do value-based contracting. I’m a primary-care physician by background. I have a group called Village Health Partners that I founded. We were the first National Committee for Quality Assurance Level-3 medical home in the middle part of the U.S. back in about 2007, so I’ve been in this value-based game for 13 years.
When I left practice, the idea was that you could take what we had done, collect a bunch of other practices in a region, and create a network of value-based care for employers and patients in our community with the idea of, “How do we help our communities thrive?”
To date, we’ve saved over $50 million in our value-based contracts. That began to attract attention from other markets across Texas. Now we have nearly 900 practices. If you ask me in a month, it’ll be well over 1,000.
We (work with) Blue Cross and Blue Shield, UnitedHealthcare, Cigna, Aetna, Medicare Advantage, Medicare shared savings. Since we (have all of those) lives under contract, the physician practices can have a single model to take care of all their patients. Unfortunately, the way value-based care is rolled out, and why it’s been so slow, is that practices have had to segregate populations with a certain management company over here, and then another value-based opportunity over there.
That kind of schizophrenia inside of a physician’s practice population makes it really hard to gain traction in a single operating model.
The key to our operating model is that we believe the physician-patient relationship is the most important relationship in healthcare today. We offer a care coordinator, case manager, social worker, pharmacy, support services like diabetic education, all kinds of (programs for) social determinants, transportation. There’s a core team … that’s virtual. They work (through) the electronic medical record.
Now, imagine how the world has changed in the last 40 days, when physicians are now working from home. That virtual care team is now a super-engaged part of everything they do. We are doing direct handoffs … “Hey, I want you to talk to John, my case manager.” Or, “I’m going to hand you over to the pharmacist, and the pharmacist will get your medicines organized and get them delivered to you today.”
We have a centralized pharmacy that’s part of our network that does well over 1,000 scripts a day. It’s part of our secret sauce … that really drives medication adherence.
On top of that we have technology. We track all of our patients who leave our offices for services outside. The same way Amazon can track our toothpaste and toilet paper orders, we are tracking our patients, where they’re going to specialists and so forth. And we make sure the specialist communicates back.
MH: Beyond the current crisis, you’ve long advocated for creating a prospective payment-style system for physicians. Why?
Crow: Fee-for-service is a reactionary, transactional relationship, so we’ve always had this absolutely incongruent payment model that goes with a service delivery model that is primary care.
My provider friends, as much as they complain about fee-for-service and rates and stuff like that, they’re scared about … the old days of capitation. The problem with capitation was there was misalignment over who had the right information. The physicians didn’t have the data back then. The physicians didn’t have the technology to be able to manage this in the way that we do today.
And now, in this moment, with this crisis, physicians are seeing for themselves how unstable fee-for-service is for them.
We got all 800-plus primary-care practices up on telehealth in 10 days. On March 1, 15% of our entire network was doing telehealth visits, and it was less than 1% of the volume on any given day. By the middle of March we had 100% on it. It now makes up about 85% of visits day to day, and we’re closing in on 15,000 visits per day.
Doctors are doing more care than ever … but there aren’t CPT codes for it. The only CPT codes for the care that we’re doing right now is around televisits and some of the care planning, but there’s so much more going on from a coordination standpoint, connecting to pharmacists, connecting (around) social determinants. There’s no code for connecting people and coordinating things in the same way that there is (in) prospective payment, where you don’t have to track every single little interaction or email.
These physicians at home right now are reaching out through multimedia to the sickest (patients)—people over 65, diabetics, and people who are on multiple medications. We’ve helped create text campaigns, email campaigns, call campaigns.
In fee-for-service, you don’t think like that. You react. You just wait for your exam rooms to fill. Now, in this new model, they’re actually doing that proactively. They’re just not getting paid for it unless there’s a televisit involved from one of the billing providers. If a nurse calls and checks on them, that’s not necessarily a billing event. But that’s a lot of care that’s going on.
The carriers I’ve talked to are all sympathetic … but say that they can’t just flip a switch. They say their systems can’t do that.
We got people on telehealth in 10 days. We opened up 40 drive-thru clinics. We’ve been able to create webinars and digital magazines out of nowhere, which is nothing we ever did before, just to get information to our members.
We need to put a little more pressure on (payers) because we think it’s vital to health and well-being to have primary care open and more accessible than ever in this moment.