The Centers for Medicare & Medicaid Services' new payment model, called the Quality Payment Program, issues a powerful challenge to primary care physicians: Improve the quality of care and save money, by focusing on population health.
What, exactly, does that mean? In part, it means that physicians will need to consider why some groups of people are healthy and why others are not — so they can make care decisions that improve the health of many people.
“Small practice physicians must participate in population health; it’s the future and it’s how they’re going to get paid,” Michener said. “It’s going to be really hard not to participate in this model of care.”
There are some straightforward steps physicians can take, he said, urging physicians to:
- Build partnerships with other care providers and health-care systems
- Ensure electronic health records, claims data systems and other software tools capture the necessary data such as patient identification and provider-performance measures
- Look for patterns in patient care
Population health management programs use software tools to aggregate patient data and provide a comprehensive clinical picture of each patient. Physicians then use the data to track and hopefully improve clinical outcomes while lowering costs.
For example, a primary care physician could look at all of her asthma patients that aren’t getting better, identifying how often they’ve been to the emergency room and why. This might lead to the realization that her patients are mixing up their prescription medications, so she needs to educate them further about when to use a rescue inhaler verses control inhaler. Or maybe the frequent ER visitors all live near each other, and there is an environmental issue.
Michener offered words of reassurance as well:
Primary care physicians need to know that they have the power to quickly analyze groups of patient data and intervene when necessary to make better treatment and care decisions that lower the cost of care, improve outcomes, and raise their ability to earn income under a value-based payment system. That’s an incredibly effective way to deliver care.
Previously: Health-care policy expert Arnold Milstein weighs in on Medicare’s plan to prioritize “value over volume” and “We haven’t invested enough in primary care”: Stanford expert talks about California’s doctor shortage
Photo by Guillaume