Implementing advanced primary care models in a fee-for-service world is nearly impossible. A shift towards more holistic, patient-centered primary care requires health systems move towards value-based contracts.
Primary care is at the heart of the care delivery system. Over three-quarters of the general population only require primary care services in a given year.
Yet primary care rates have been declining in recent years.
Such a contrast between need and utilization can be linked to a number of factors including poor care coordination, lack of disease management, and mistrust in providers often seen in the fee-for-service world.
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Changing this requires a focus on more holistic and patient-centered care through advanced primary care models that leverage value-based reimbursement.
“The advanced primary team needs to stay in the quarterback seat with the patient as opposed to the patient getting sucked up into specialty land where there are multiple specialists managing their care,” said Ryan Schmid, MBA, CEO and president of Vera Whole Health. “That is what the advanced primary care team is designed and trained to do.”
During a recent episode of Healthcare Strategies, an Xtelligent Healthcare Media podcast, Schmid outlined their organization’s advanced primary care model.
“We think of whole health: social, mental, and physical wellbeing,” he explained. “Unless you build a care model that’s designed to treat the whole person as opposed to physical disease or infirmity, then it’s really not advanced primary care.”
One of the most important things advanced primary care models need in order to succeed is financial alignment among stakeholders.
“In our world, that means the patient, the care teams, the company, and then whomever we’re contracting with. Unless everybody has the same financial goals in mind, you’re just recreating some version of a sick care fee-for-service world,” Schmid insisted.
The shift towards value-based contracting starts with value-based care delivery. In order to do this, Vera Whole Health focuses on four key pillars.
The first is a care team approach built specifically for Vera’s population. The care team is made up of physicians, nurses, social workers, behavioral health specialists, and other care providers.
“It’s not enough to throw a bunch of folks wearing different hats in the same building,” Schmid said. “They have to be functioning off the same care plan for individual members and offer a broader population health strategy for whichever population we’re serving.”
Next, advanced primary care needs strong and actionable data to support the care team to support them in delivering high-quality care. Data should identify gaps in care and screening tests should help identify need.
“The third pillar is that data has to support a true population health strategy based on risk at the moment,” continued Schmid. “That means that the traditional population health risk pyramid of low risk, rising risk, and high risk is too static for a true advanced primary care solution.”
Preventive care can help an individual who is rising risk to slow and even stop from developing more serious chronic conditions. Ignoring this population, though, can lead to a quick escalation of chronic conditions that could have been avoided. Understanding the population in real-time will help the care team understand treatment options that are consistent with the organization’s population health strategy.
The final piece that allows all these pillars to come together is care coordination. A majority of a patient’s care can be delivered in an advanced primary care setting, but when it cannot, providers should point their patients to high-quality, low-cost specialists.
Schmid argued, though, that empathy is truly at the center of their care delivery model.
“I would stress the empathy piece of this whole deal. It’s a non-negotiable. The one thing we’ve nailed is empathy,” he concluded. “Even when we didn’t have all the bells and whistles that we have today, we saw outstanding results. That is the secret to unlock this whole thing.”
Source: RevCycle Intelligence