Like many of you, I have been following the confirmation hearings of the nominee to lead the U.S. Department of Health and Human Services. I am eager to learn what will be altered and what will remain of the past eight years of change in American health care.
We’ve seen, for instance, enormous change driven by the CMS Innovation Center, which is pursuing new models of care and payment reforms that improve outcomes, reduce costs, and give patients a better experience. The move is away from fee-for-service and toward value-based care. Payment is not calculated by the number of tests, procedures and office visits provided — but rather on the ability of providers to keep their population of patients as healthy as possible.
Will the train toward value-based care switch tracks with the new Trump administration?
In a time when making any political predictions seems perilous, I will nonetheless say this train transcends politics and will keep moving forward. There is general consensus on both sides of the aisle that reducing costs by providing the most appropriate care for patients — in the least costly and most effective setting — is the right way forward.
At the Quality Institute, we have partnered with the New Jersey Innovation Institute (NJII) through their Garden Practice Transformation Network to engage thousands of physicians to help them prepare for alternative care and payment models. The NJII team of about 25 practice transformation coaches recently met with some dozen coaches from Horizon Blue Cross Blue Shield of New Jersey, which has been involved in practice transformation work since 2010 through their value-based programs. We brought the teams together so coaches could share their insights and experiences. Many of you may know that prior to joining the Quality Institute I was on the executive team at Horizon dedicated to redesigning care delivery and payment reform.
At our meeting, I listened to the NJII and the Horizon coaches talk about the challenges of supporting physicians, nurses, and practice managers on transformation. I recall one of the coaches described how to mine the existing office for staff with undiscovered talents, say someone with a knack for computers who could create electronic medical record reports.
The use of technology is essential to transforming medicine. Physicians can learn in close to real time if one of their patients has been admitted to the hospital or emergency department, for instance. The physician, or a care coordinator at the practice, can then reach out to provide proper follow up, and perhaps greater outreach, to prevent future hospitalizations. That’s good care. Technology can also help practices identify, say, diabetic patients with the highest A1C levels who need extra attention. The coaches called transformation an on-going process, and they said it’s important to show providers how it’s helping their patients. A pulmonology medical records report, for instance, could show providers the patients with pulmonary disease who ended up in the hospital, and who could benefit from a relatively inexpensive nebulizer at home.
I am thankful for the many Quality Institute members who helped us recruit physicians into the Garden State Transformation Network, and who have been subject matter experts on for the network’s monthly webinars. We all benefit when providers take responsibility to create true patient-centered care.
With the Trump administration, we may see some slowing down of deadlines and mandates as some physicians have argued change is coming too swiftly. But I do not foresee a major shift in the market forces driving the move toward alternative payment models or use of electronic medical records. Models of care and payment are changing. Providers will no longer be able to sit back and wait for their patients to call them.
Those days will soon be over, no matter who sits in the White House.