How Can Health Care Purchasers, Providers Better Coordinate to Improve Value-Based Care Delivery? / HealthChoice

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hello i'm matthew gavidia today on the mgh life sciences medical world news the american general manage care is pleased to welcome dr norman chenwen vice chairman of the council of accountable physician practices or capp can you just introduce yourself and tell us a little bit about your work sure i'm i'm norman chen man i'm a family practitioner by training uh i founded austin regional clinic with which is currently the largest outpatient delivery system in austin texas with 340

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physicians and 28 locations i've been a member of cap for its entire duration which is approximately 15 years cap or council of accountable physician practices promotes the organized delivery of care through physician-led medical groups whether they're in conjunction with a larger system or stand-alone austin regional clinic happens to be a stand-alone physician-owned physician-governed group but

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many of the cap groups are your large nation-brand groups such as kaiser permanente mayo cleveland et cetera amid the coven-19 pandemic can you give insight onto the current state of the us healthcare delivery system so with the onset of covid um it reminds me of what warren buffett once said which was that when the tide goes out you find out who's not wearing a bathing suit and with covert the tide has gone out

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and it has shown a lot of disruption in the delivery system shown that we're we haven't been prepared it has put a lot of financial stress as well as just care delivery stress on the system i think that groups like cap groups larger groups that have infrastructure and professional management and have plan planning capability into the future have fared better than smaller groups that are pretty much

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reliant on their day-to-day cash flow but all in all of the american health care system has not uh not acquitted itself terribly well though there's been a lot of creativity and response and i think at this point we have all segments of the system doing their best to get back in the game uh telemedicine has been a lifesaver most of the cap groups have been engaged in telemedicine for many years and uh it's it's been a but even for us

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it's been something of a revelation of how well accepted telemedicine has been when it was the only alternative what are some of the factors that warrant consideration among employers and health care purchasers when it comes to developing health care plans and what are some of the common mistakes too so i wouldn't say there are common mistakes i would say that the system is afflicted by two factors one very very fragmented so pieces of care are delivered by different entities that are not necessarily

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aligned with each other or even in communication with each other and the business model is a fifa service business model which means you only get paid if you do something to a patient as opposed to really the alignment would come in being paid for keeping people healthy and well and that's the that's the reward that's the goal we should want we shouldn't want people to be sick so we can do something and get payment and what that does it

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means that there's no upfront um ability to invest in keeping people well now groups like cap groups have do have contracts with health plans and with employers where we do have upfront financing that allows us to build in infrastructure to help our patients take care of themselves to do outreach to monitor quality uh to connect the system together

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and electronic medical records uh have been a boon they've been expensive and complicated but again larger entities have been able to connect with other entities and provide more integration in the care delivery in the new report by the national alliance and the cap exploring employee physician collaborations to deliver quality care the volatility of the u.s healthcare delivery system was a major takeaway can you further discuss report findings and what employers and healthcare

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producers are seeking based on the current market yeah so so this this initiative and this report is about communication from providers of care directly to uh employers who are purchasing care on behalf of their employees so self-insured health plans and and the goal was to open up a line of communication and as strange as it may seem there historically has not been good communication between the purchasers and the providers

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because there's so many middlemen and middlemen being health plans in particular but also brokers and consultants and i think it's a lot easier to solve a problem if you're talking to somebody directly so this is rather than playing the game of telephone i i tell uh the health plan the health plan tells the broker the broker tells the employer and then the message comes back the other way we're trying to shorten that chain and understand better what employers want

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what they need how they'd like to fix things and and again i don't think i would call it volatility i would just say that the health plan is not health plans and the way the health delivery system is designed it's not delivering an acceptable product or service to the employers and their their dependents and employees how can employers and healthcare purchasers optimally transition to delivering high quality and affordable

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care so if you read the report you find that the problems that people have been aware of and in particular the large employers and medium-sized employers there's just a lack of coordination as i mentioned before fragmentation is a big issue so the more you can coordinate the care around the patient the better the experiences for the patient the more likely you're going to get a good outcome so again investing in the delivery system so that

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we can make those connections and make them smooth and capable makes a big difference in addition there's clearly been inadequate access for to behavioral health and there's been an inadequate citing of behavioral health services within the primary care delivery system so there's just disconnect and that's that's a fragmentation yet again if it is possible to bring behavioral

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health into the exam room and it is and particularly now with telemedicine we can improve the patient experience and and really avoid some of the failures delivery the third issue has been just literally under investment in primary care there have been many many studies across the years that show that patients who use primary care as their front door to health care do better

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or have less expenses have better outcomes and are more satisfied with the care they get but as we all know primary care is poorly reimbursed the united states again part of the fragmentation and also the way healthcare delivered has developed over the years you specialists get paid enormous sums of money primary care scrapes by that's okay i'm a family practitioner i'm not complaining but

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uh but there's been under investment in organizing primary care and making sure primary care can act as a real facilitator for patients care um there's not employers really um have spoken out in these meetings about the lack of transparency of how health care is paid for they don't understand the billing mechanisms and uh that's not surprising because they're they're very uh complex and elaborate

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um i have to have an enormous staff just to build and collect for my services so you know i can go down to home depot and buy a lawnmower that's very simple i understand what i'm getting uh i understand where the money went in healthcare if you're going to have an aptly debt appendectomy you're not quite sure how much your health plans can pay for it you're gonna get bills from four or five different entities the anesthesiologist the laboratory the hospital the primary care doctor the

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surgeon it's crazy uh it's it's it's a system that needs to somehow be wrapped together and made more transparent so people know what's going on and then lastly again i've already mentioned this that the the way that reimbursement is structured does not encourage incentivize or reward physicians for continuity of care for their patient and that has been changing over the

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years but not quite enough medicare advantage is an example it's a shining example of a change in the way healthcare is reimbursed where the delivery system is reimbursed for good outcomes for measured quality for patient satisfaction and and for access so i would say that if you think about what you really want out of health care is you want a patient satisfaction a satisfied customer you want access so when somebody's sick

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they can get the care they need and that's also a problem because of fragmentation you want there to be quality and you want that quality measured healthcare is it's difficult to know who's providing the best quality who's doing the best surgery who's managing diabetes better than someone else because that has downstream consequences and lastly what's the overall cost not the cost for a unit price which is what we have in

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fee for service so an office visit is x number of dollars the surgery is wide number of dollars this that really doesn't matter to the person who's ultimately paying the bill because it's what the total cost of care was and in an in an unmanaged and um not chaotic but but not organized system the costs go up and the quality goes down and to build on top of that what are the next steps to further delineate what needs to be changed or altered in the

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current u.s healthcare delivery system so i i have my own personal views i think we're in the midst of this process and i think more discussion between our groups the cap groups and the national alliance groups of healthcare purchasing organizations coalitions i think we have to understand each other better what what was very clear if you read through some of the deliberations and discussions was

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that for the most part employers did not understand how the system worked they didn't understand where the incentives were they felt overwhelmed they have been relying on outside experts or intermediaries to explain the system to them but that that has not worked well again i think it's a game of telephone the message changes as you guys pass it on from one to the next as opposed to being a direct message so i think the goal right now is really uh

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to uh to see us continue this discussion and and start to work out solutions a little bit at a time this is a huge complex system there are our group alone has 50 different payers that we contract with if you step back and look at the system as it is there there are all kinds of tranches so you have medicare patients medicaid patients i spent two years on the navajo reservation in the indian health service then you have the military and the va is not the

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same as the military it just goes on and on in our city we have a substantial population with no coverage whatsoever so there's a safety net system that travis county provides it's very hard to organize yourself around such a system or it's actually a non-system an anti-system so i think there's just got to be more exploration and and then experiments experiments can can we change the payment model and

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develop incentives and rewards for the system responding to the the change payment model and bring in behavioral health where which is poorly reimbursed at this point and maybe give more assets and infrastructure to primary care so we're much better able to take care of our patients and be aware of where what their needs are and lastly are there any other concluding thoughts that uh you may have that has not yet been addressed i appreciate the opportunity

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to to raise this issue on a larger stage um i think there's a lot of work yet to be done um again you know topid is is really a side issue in many ways but it was the tide going out and we're all standing around with our bathing suits around their ankles and we need to fix all of that and and really prepare ourselves for the next pandemic which there surely will be one and we need to organize the way we

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deliver care better to learn more visit our website ajmc.com i'm matthew vidya thanks for joining us

How Can Health Care Purchasers, Providers Better Coordinate to Improve Value-Based Care Delivery?

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