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National Association of Managed Care Physicians Fall Forum 2019

Are Value-Based Models Helping or Hindering Care Delivery for Primary Care Providers?

Jaime Rosenberg
Value-based models continue to enter the healthcare system, affecting a variety of fields, including primary care. And while success stories have been shared by payers and CMS touts these models as a way to “save” primary care, that's not the current reality, said Theresa Hush, chief executive officer of Roji Health Intelligence, LLC, during a session on population health management at the National Association of Managed Care Physicians 2019 Fall Managed Care Forum, held October 10-11 in Las Vegas, Nevada.

“Their comfort with being in risk and their ability to deal with risk either by capacity of their own work or their general burnout are intertwined, and until we resolve the issues of their ability to practice in a way that is good for patients and for them, then we’re not going to make a lot of progress with good results and high risks” explained Hush, noting that primary care capacity is the number 1 thing hindering PCPs from being able to effectively take on value-based models.

Physicians are also now required to implement certain skills they haven’t yet been taught, including motivational interviewing, shared decision making, and addressing social determinants of health, as well as an understanding of the data needed to be collected and shared, said Hush.

These data required for improving risk spread across 4 categories:
  • Patient data, including risk adjustment data, social determinant of health data, patient goals for highest risk, claims data, and predicted costs
  • Referral data, including cost profiles, quality and outcome data, volume, and patient costs per member per month
  • Cost data, including per member per month/per member per year, predicted to actual, episodic by chronic condition, and variances by patients and physicians
  • Quality and outcomes data, including outcomes compared with patient foals, outcome improvement over time, and variances by patients and physicians
As a result, change is needed, she explained. And, there are several aspects of care that PCPs are overwhelmingly looking for:
  • Rules for the game of risk, and a voice in choosing options
  • More resources to support the risk they do
  • More time with patients
  • More data and information for medication decision making
  • Seeing patient cost and outcomes over time
“We’ve all discussed how we need to lighten the physician load, we need to being more resources to bare, we need to figure out methods of gathering data that aren’t burdensome for physicians, and so on, but we don’t have a clear best practice for doing that,” said Hush.

Patient data gathering needs to be part of intake so the physician should know what’s going on before they have the appointment; there need to be roles for support, coordination, and communication; and there needs to be a sharing of best outcomes in teams to focus on what works, concluded Hush.

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