An Overview of the Value-Based Marketplace - Episode 5
Michael Thompson: One last point on consumerism. We talk about a thousand moving parts. How do we support people in navigating a thousand moving parts? Because you don’t know which part you’re going to need at the beginning of the year. You’re not going to know it in open enrollment. So how do we help people navigate that? What are you seeing that’s working?
Patricia Haines: Well, I’m actually hearing a lot more points for care navigators, and I think it’s because physician offices aren’t doing it. If the carrier calls to precertify or to their typical case manager, there’s not a high level of trust between a patient and the insurance company, however they see that. And so outside that, I think care navigation really has a role of pulling all the pieces together. I’ve been a skeptic. I’m turning a page.
Andrew Crighton, MD: I would agree, and I think looking at it from the patient’s point of view, I’ve had cases where a carrier will deny a procedure, the person is still in pain, but then there’s no other follow-up; nothing else is offered. I think a care navigator will say, “OK, well, this was denied, but you’re still in pain. Let’s get you to the appropriate resource, and let me help you along this way.” I think it’s needed. It’s hard to navigate the system. Even as a physician, it’s hard.
Bruce Sherman, MD: It is a complex system. I would completely agree. And my sense is that navigator may be even too passive a word, that advocate may be even more appropriate because individuals need help along the continuum of provided services to ensure that people are plugged in and connected. I would, perhaps, take a little bit of issue. I think primary care clinicians are perhaps the most well positioned to provide that service.
Patricia Haines: I couldn’t agree more.
Andrew Crighton, MD: They are.
Bruce Sherman, MD: If they are given the opportunity to do so, individuals don’t have the cost barriers in front of them to access primary care. I see that as perhaps the setting where that advocacy could have the most benefit.
Michael Thompson: It’s interesting. Advocacy obviously is a patient-centered, employee-centered benefit, but it also actually adds a lot of value in the system. The programs that have been put in that place have actually proven out to actually reduce cost trend and get people to the care they need faster.
Patricia Haines: Right time, right place.
Michael Thompson: Right time, right place. And all the tools, all the stuff that we’ve built in the context of consumerism, get used more if somebody actually helps people. But a key ingredient—and I think you were alluding to it, Pat, before—to be an advocate is to be trusted and to be trustworthy, to actually be working on behalf of that patient to help them get what they need.
Patricia Haines: Yes. I want to underscore the primary care. I couldn’t agree more. I don’t think there are enough of them. I don’t think they have enough time, and I don’t think they’re paid enough.
Bruce Sherman, MD: I think your point about pay is a critical one. This is a role that I think has not really been fully matured in the current delivery system, and we need to support that advocacy role as a way of ensuring that people are getting the right care at the right time in the right location.
Patricia Haines: You’re both physicians. Any time I’ve talked to somebody who’s entering medical school, in the middle of medical school, or picking a specialty, they’re not doing primary care.
Andrew Crighton, MD: No.
Patricia Haines: Because the view is there’s still no respect, and there’s no income.
Bruce Sherman, MD: I agree.
Andrew Crighton, MD: Yes. Going back to the managed care comment, which started this whole thing, with the idea of a gatekeeper that was the primary care physician, there was almost an adversarial relationship that I think set the stage for that being less attractive, less valued, and therefore not reimbursed correctly.
Michael Thompson: I’m going to close the conversation as it relates to consumerism. I think what we’re hearing here is that we’re not moving away from a consumerist-oriented strategy for employers and for the system itself, but it’s not necessarily consumer directed as much as it is consumer centric. How do we help people get the care they need? How do we design our plans in a way that they can afford the care they need? And how do we get them activated so there are value-based choices throughout the continuum?