I am still humbled by the opportunity to represent Doctors for America at the White House on June 6th for its “Physician Conversation on Care Coordination.” The event was attended by approximately 200 physician leaders from specialty societies, large health systems, small practices and organized medicine. I, along with Doctors for America members Allen Kachalia, Asaf Bitton, Eleanor Greene and Michael Newman shared the results of our membership survey directly with the White House.
The crux of the event: many in this country are making substantial progress in reaching the Triple Aim of improving individual patient care, improving population health and lowering the costs of care through Accountable Care Organizations (ACO) and Patient Centered Medical Homes (PCMH). These ideas need to be shared, and scaled up to be spread across our health care system. Many providers raised concerns about EMR interoperability, lack of resources to implement system reform, and making these changes amidst our current fee-for-service system. Every physician leader in the room, however, believes our fee-for-service system’s remaining life span warrants a hospice referral!
Presenters included the Center for Medicare and Medicaid Innovation, as well as the community health center Unity Healthcare, The University of Michigan, Montefiore Medical Center and Seaport Family Practice. The presentations, and the dialog that followed, provided me with immense optimism for the future of Health Care. Representatives of the American Medical Association, some specialty societies such as Orthopedic Surgery and Anesthesiology, and even a solo practitioner from Delaware were participants in a grand exchange of ideas enabling progress. It was truly inspiring. Specialists voiced their concerns about their place in Medical Homes, driven by primary care, but the presenters shared data that their specialists have higher work satisfaction because they are free to practice their specialty, since social and primary care needs are better addressed in a PCMH.
Unity Healthcare has been employing a team approach to patient care, with team huddles each morning: physicians working in concert with nurse care managers and social services to address patients where they are. This has enabled better care at lower costs with impressive outcomes.
The University of Michigan, with 1600 physicians (300 of whom are primary care) is operating in a patient-centered model of care which leverages pay-for-performance mechanisms among its caregivers. Paramount to their approach has been patient engagement as well as provider participation, so as to allow constant tinkering through feedback from both groups. U Mich also has worked through multiple payers, including Medicare, Medicaid and private health insurers, so all patients are treated equally.
Montefiore Medical Center is a pioneer Accountable Care Organization (ACO) with 23,000 Medicare beneficiaries under their care. What was most astounding was that many of those patients are impoverished, and are eligible for both Medicare and Medicaid, and roughly 50% carry a behavioral health diagnosis. Through a robust care manager program and mental health resources, Montefiore’s physicians are seeing better outcomes among their patients, and have widely embraced these delivery system reforms.
I was personally most touched by the experience of Seaport Family Practice. Over a decade ago, this 5 physician private practice hired its first mental health therapist in the 1990s. It adopted its first EMR in 2000, and recently implemented its 3rd EMR upgrade. They employ a community health team which makes home visits, and through data accrued by its EMR specifically focuses on its sickest and socioeconomically neediest patients. It has diversified its funding, partly from being a rural health provider but also from receiving ACO bonus payments from the savings in the cost of care they provide. This has allowed for imaginative innovation and flexibility, with spontaneous formations of group sessions for patients improving their engagement. One anecdote involved an elderly male patient, a widower, who was very depressed. Having trouble getting to what that patient needed in a 20 minute office visit, his doctor decided to inform the patient of a support group for other widowed men. The catch – that support group did not yet exist! But this compassionate physician decided to recruit other men in his practice and started up a support group – which has led to incredibly specific and effective care for exactly what that patient needed. The group sessions are inexpensive, allow for peer support (free) and have led to fewer hospitalizations for participants.
The Center for Medicare and Medicaid Innovation has been at the center of this groundbreaking study of new delivery systems, and spoke of its Comprehensive Primary Care Initiative to continue to promote and study new models of care. CMS is partnering with private health insurers to further incentivize physicians to reach for the Triple Aim. As a private practitioner with 3 practice partners, the idea of delivery system reform is daunting. But this collaboration gives me great hope that all physicians (employed or on our own) can adopt reforms that put our patients first. I hope to explore in a future post the idea of a virtual integrated provider association, as this seems promising for small practices to pool their limited resources to better function as a PCMH.
On a personal note, I derive tremendous personal satisfaction from my visits to the White House and Capitol Hill. To learn of impending improvements to our fractured health care system gives me energy to care for my patients (as I did today, after 2 days of advocacy in DC) in my small practice. You can learn firsthand what it means to contribute to health system changes by joining me and the many dedicated members of Doctors for America.