“The Wizard of Oz” is a wonderful movie, full of metaphors that can be applied to real life. As I look at the current state of Healthcare, I can’t help but wonder if there is a true “yellow brick road” from volume based care to value based care. If there is, which stops will we make along the way and what roadblocks will we face?
Physician engagement is a crucial component on the road to value-based care. As Michael Porter and Thomas Lee mentioned in their article in the Harvard Business Review, “care fragmentation is reinforced by the fee-for-service model in which each doctor, specialist or otherwise, is paid separately, while the hospital receives its own payment.” They go on to mention that crucial services, like care coordination, are often not reimbursed, thus further fragmenting healthcare.
As our population ages, these crucial components will need to be addressed as practices, hospitals and payers will be flooded with patients needing coordinated services. So how do we engage our physicians in this battle? Like the Scarecrow, listening and learning needs to take place. We can allow clinicians to work to the level of their licenses to unburden the physicians by coordinating patient care and documentation which becomes available for the treating physician. This will then allow the physician to spend quality time diagnosing and treating the patient, patient and physician satisfaction will rise and overall medical costs will decrease. Payers, Accountable Care organizations (ACO’s), Patient Centered Medical Homes (PCMH) and governmental regulators will see the health care value being generated. With value-based care, these services should be included in reimbursement and quality care should be rewarded. Sounds simple, right?!
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In addition, implementing telehealth services could take us further down the road to value-based care. Like the Lion, we must have the courage to invest in new technology and workflows to improve patient care. Dr. Rasu Shrestha of the University of Pittsburgh Medical Center (UPMC) recently commented that UPMC is “able to reimburse directly to the physicians for the remote care we are providing. We’ve been continually increasing the specific types of reimbursements that are being provided for a wide variety of disease processes.”
They are currently using telehealth to remotely evaluate stroke patients, review crucial radiologic findings, perform post-op visits and are starting a chronic condition monitoring program. Dr. Thomas Watson, executive director of telemedicine for the UPMC, and a practicing colorectal surgeon notes, “People are focused on fee-for-service billing, but what’s actually important is the concept of cost avoidance,” Watson explains. “It requires working with payors and managing patients over time as part of a population, instead of as a single episodic encounter. In the broader sense, it is fairly straightforward.” But can we universally reimburse providers for this type of care? Let’s hope so.
Finally, like the Tin Man, we must develop the compassion and heart to realize that all people deserve healthy lives and healthcare providers and physicians deserve to be compensated for providing quality care. I would like to believe that the majority of healthcare providers chose their careers because they wanted to help others stay well, not just to earn a living. Let’s not lose sight of that.
So can the “yellow brick road” take us to the Land of Value-Based Care? I’ll leave that up to you. Please send any thoughts to me @DrMarcieSC.