Tuesday, November 19, 2024

Helping make value-based care work for primary care

Value-based care has been heralded as the future of healthcare for more than a decade, but it has yet to fully arrive.

This gap is particularly evident in primary care, which must be on board if the promise of value-based care (VBC) is to be achieved. The Commonwealth Fund, a private U.S. foundation dedicated to improving healthcare, recently issued a report exploring why primary care has been so slow to adopt VBC.

According to a 2022 Commonwealth Fund survey, just 46% of primary care physicians (PCPs) reported receiving any value-based payments. Commonwealth Fund researchers found that PCPs weren’t opposed to VBC in principle. In fact, they long to get off the fee-for-service (FFS) treadmill, enabling them to spend more time with patients while providing comprehensive, proactive care. The problem, they say, is that VBC and its payment models are not designed or implemented in such a way that makes it possible for them to participate.

The solution is not to abandon VBC, but to make it work for primary care. Until the model is refined and provider concerns are addressed, independent PCPs are stuck between staying with FFS and its inadequacies or running the risk of failing under a VBC model that doesn’t work for them.

One immediate solution for primary care practices is to collaborate with an organization known as a Value-Based Care (VBC) “enabler.” These enablers help to mitigate the ongoing challenges within VBC, offering a smoother transition for PCPs to adopt this alternative payment model.

Let’s delve deeper into the major barriers and explore potential solutions.

Administration – The average PCP who provides services to patients covered by Medicaid needs to see on average 25 patients just to break even. This financial strain is compounded by the varying quality metrics imposed by managed care organizations that oversee VBC contracts. Consequently, many PCPs find themselves overwhelmed by the additional paperwork and tasks required. Smaller, independent primary care practices, in particular, lack the necessary resources, such as staff and technology, to manage these demands. As a result, these practices often struggle to earn VBC payments or opt out of VBC arrangements altogether.

These practices require technology that can seamlessly integrate patient data from various sources, including their own electronic health record system. This technology should enable them to analyze and manage the data necessary to deliver high quality, evidence-based care including identifying patients who need to be prioritized for wellness visits, chronic care visits, or transitions of care, regardless of their payer. Fortunately, such technology is available through VBC enabler organizations, eliminating the need for practices to invest in new technology infrastructure, which many cannot afford.

Finances – PCPs may be wary of payer contracts that put them at financial risk, particularly if their panel consists of higher acuity patients. Outcomes-based reimbursement can be unpredictable, akin to a black box that is unknowable until year-end (or even later due to dependencies on claims processing).

Because VBC enablers often concentrate on specific patient populations – such as those covered by Medicaid – these organizations may be particularly suited to helping PCPs navigate financial structures that are less familiar. As well, in some cases, enablers may be willing to take on downside financial risk or provide upfront payments based on addressing various gaps in care, providing further financial stability to PCPs.

Patient engagement – PCPs often experience frustration when trying to improve their patients’ treatment adherence amid challenges related to social determinants of health (SDOH). For instance, a patient may need help managing multiple chronic conditions while also facing unmet social needs, such as food instability, which further complicates their care. A VBC enabler, particularly those focused on Medicaid populations, can help address SDoH, which heavily impacts a patient’s overall health and their ability to access care. A VBC enablement partner may also complement care provided by PCPs with multi-disciplinary field teams that include nurse practitioners, care coordinators and even chaplains, to address SDoH and help patients re-engage with providers and receive personalized care.

The VBC enabler helps payers, as well. Here’s how:

Network optimization – Payers need to align more of their network providers into VBC agreements at a scale that allows them to share risk and reward. They also must optimize network performance, particularly with outlier practices. This can be accomplished as the VBC enablement partner brings more PCPs into the network through a proven clinical model, proprietary technology and an activity-based payment structure that corresponds with overall goals. Payers benefit as it becomes easier for providers to meet VBC goals and transform their care models to promote health and well-being.

Health plan dynamics – Payers need more effective strategies to improve quality and cost outcomes for members with complex needs and those who have been historically marginalized in terms of healthcare access. Additionally, payers must find ways to differentiate themselves within their respective markets.

An enabling partner provides PCPs with the technology, analysis, financial support and SDoH initiatives to allow them to deliver high-quality care, with a particular focus on marginalized and underserved communities. This helps payers meet their goals. Additionally, the partner’s deep connection and support in communities helps payers develop a strong presence.


Proven results in Medicaid


VBC models augmented by an enabling partner have been proven across thousands of PCPs and multiple states. PCPs, particularly those in disinvested communities, should find an enablement partner that can remove administrative and operational challenges to support them and health plans in achieving VBC success. These supportive partners align, engage, and assist providers and payers, allowing them to focus on the patients and communities that need it most. Ultimately, all parties, especially patients, benefit and thrive.

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Friday, November 15, 2024

Prominent academic institutions launching Healthcare AI Challenge

A diverse collection of academic health care institutions, and their respective health care professionals, are launching The Healthcare Artificial Intelligence (AI) Challenge, hosted by Mass General Brigham AI. The Healthcare AI Challenge is a virtual, interactive series of events which health care professionals can explore to assess the latest AI health care technologies in real-world scenarios, including features like medical image interpretation, in simulated environments. Health care professionals with relevant credentials can then provide feedback on the performance and utility of the technology, which will generate publicly available insights and analytics.

“The velocity of AI innovations and breadth of their health care applications continues to increase. This unprecedented growth leaves clinicians struggling to determine the effectiveness of these innovations in safely delivering value to health care providers and our patients,” Keith Dreyer, DO, PhD, chief data science officer at Mass General Brigham and leader of Mass General Brigham AI, said in a university release.

“The Healthcare AI Challenge is a collective response to the complexities involved in advancing the responsible development and use of AI in health care. This new approach strives to put clinicians in the driver’s seat, allowing them to evaluate the utility of different AI technologies and ultimately, determine which solutions have the greatest promise to advance patient care.”

Participating and collaborating institutions include Mass General Brigham, Emory Healthcare, the Department of Radiology at the University of Wisconsin School of Medicine and Public Health and the Department of Radiology at the University of Washington School of Medicine, in addition to their associated health care professionals. The American College of Radiology (ACR) also joined the collaborative to ensure access to the challenge for its 42,000-member community.

According to the Mass General Brigham release, the collaborative intends to foster continuous, consistent and reliable expert evaluations of health care AI by crowdsourcing input from credentialed health care professionals. “We need to go beyond collaboratives that come to consensus on how to think about AI,” explained Alistair Erskine, MD, chief information and digital officer at Emory Healthcare and Emory University. “We need health care delivery communities to provide real-world experience of the application of AI at the point of care. That is what the Healthcare AI Challenge is designed to do.”

Contributing institutions collaboratively agreed to begin the challenge with radiology-based AI solutions, given the historic use of AI in the field. “Medical imaging provides many types of data, and up to 95% of health care data is unstructured, non-text data,” said Richard Bruce, MD, associate professor of radiology and vice chair of informatics at the University of Wisconsin School of Medicine and Public Health. “AI has the potential to interpret and distill that data at a new scale and speed, but what we need is the ability to quickly test and compare different AI solutions. The Healthcare AI Challenge will offer a platform to evaluate and compare tools across various clinical situations.”

Health care professionals at collaborating institutions can test any of the foundation models across a series of challenges before rating their clinical skill level. The scores will contribute to the insights and analytics rankings, which can serve to provide stakeholders and the public with a transparent analysis of AI solutions’ performance across various practical scenarios. Feedback can be considered by the public and can provide valuable insight to developers, who can enhance the technologies to ensure that they are fit-for-purpose, commercially viable and clinically relevant.

According to Mass General Brigham, The Healthcare AI Challenge will continue to innovate, adding new AI solutions to its interactive environment. Results from the challenge will be publicly available here.

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Wednesday, November 13, 2024

Back to basics: Putting patients first

There is nothing in my practice of medicine that equals the joy of focusing on patients and making every effort to ensure that each encounter fosters a positive doctor-patient experience.

Well, maybe one thing that exceeds that satisfaction is positive outcomes.

In my experience, the patients with whom I've developed close and trusting relationships seem to be better at following treatment plans, which helps improve positive outcomes.

For decades, research has found strong indicators that the quality of the doctor-patient relationship impacts health outcomes. One significant finding is that the physician's knowledge of the patient's disorders and emotional state is associated positively with whether the medical problem is resolved. Evidence shows that patients who feel they are not heard or respected by their doctors experience poorer outcomes.

A study from Massachusetts General Hospital finds that improving the doctor-patient relationship can produce health outcomes as beneficial as some common treatment protocols. It concluded that strategies such as making consistent eye contact, being attentive to patients' emotions, and helping them set goals can improve patient satisfaction.


Enhancing the doctor-patient relationship grows your medical practice


Start by recognizing that every patient is a walking advertisement for your practice. Suppose you have a satisfied patient, like any satisfied customer. In that case, they will tell 9-15 others about their positive experience. In contrast, 13% of patients (customers) with a negative experience will tell more than 20 people.

Access to your practice impacts the patient relationship

An important metric for patients is their ability to access the practice. It should be a goal to accommodate new patients within three to five days of their first telephone contact with the office. Ideally, established patients should be seen within two weeks of their request for an appointment. Of course, urgencies and emergencies should be seen the same day they contact the office.


Telehealth nurtures patient engagement


During the pandemic crisis that impacted doctors and patients, telemedicine improved the efficiency of the practice and made access to it much easier. Patients who can arrange a virtual visit the same day they call for an appointment are highly satisfied.


Delegating enhances efficiencies


One of the main complaints that today's patients have with their providers is that the doctor spends too much time looking at a computer screen and not at the patient. This situation can easily be resolved using a scribe or one of the new voice-to-text software programs to perform data entry. This process change enhances the doctor-patient relationship as it improves practice efficiency, allows doctors to see more patients each day, and has fewer records to review at the end of the day. This translates to less" pajama time" or time in the evening when doctors struggle to complete their medical records. This situation also leads to increased physician burnout.

If you can't employ a scribe, be attuned to engaging with the patient as you take notes. Explain what you are doing and the need to immediately update medical records in this manner. You can take a small break from typing to talk directly to the patient. Make eye contact. (Just think how you would like to be treated as a patient.)


Everyone appreciates timely follow-up


All phone calls, emails, and text messages should be addressed within 24 hours. Your patients will have a favorable impression of the practice if the lab and imaging studies results are reported to them within a day of a procedure or test.


Make use of online tools


The patient portal is an opportunity to increase your patient engagement. Patients can ask insurance questions, request refills, and ask follow-up questions of the provider, all at the patient's convenience. In fact, patients today expect an online experience with their doctors just like they receive from banks, hotels, and airlines.

Bottom line: A patients-first philosophy is an attitude and a strategy for a successful practice. Putting patients first means making every effort to ensure that each patient has a positive experience with your practice. Remember, it's never crowded on the extra mile!

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Tuesday, November 12, 2024

Patients like being asked to share personal details they want physicians to know

Physicians may find success in building patient relationships by asking patients about themselves before they arrive for their appointments.

Electronic health records (EHRs) can help build a rapport even before patients show up for an examination, said researchers Samantha Barbour and Elizabeth A. Fleming of the University of Wisconsin School of Medicine and Public Health.

In the university’s Department of Family Medicine and Community Health, they used EHRs to message adult patients three to 14 days before an initial visit with a primary care physician. Messages included a greeting, an introduction to the project and the invitation to respond to: “What do you want your health care team to know about you as a person?” Physicians then used the responses to guide the introductory portion of the visit.

The doctors liked it, and generally so did patients.

“From the clinician perspective, we found that reading patient narratives fostered an immediate sense of connection, facilitated agenda setting, and improved the sense of efficiency of the visit,” the study said. “This innovative strategy to integrate patient-owned narrative into the EHR facilitates a better understanding of what is important to patients and could be easily implemented by an individual clinician or health system.”

As for patients, 79% reported having a positive experience, with 17% neutral and 4% negative, according to the study.

Their responses dealt with:
  • Personal information, 73%. Topics included relationships, occupations, identity, hobbies, geography, defining life experiences and education.
  • Health: 67%. Topics included current concerns, health history, health goals and previous health care experiences.
  • Reactions to the message: 40%. Patients shared expectations of providers and visits. Two responses were unsure about what to say, while two offered positive feedback and one was negative.

Barbour and Fleming noted the question was taken from the U.S. Veterans Administration’s My Life, My Story project. Their study, “Using the Electronic Health Record to Facilitate Patient-Physician Relationship While Establishing Care,” was published in Annals of Family Medicine.

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Monday, November 11, 2024

Regaining happiness in our medical careers

In the previous blog, I discussed why physicians are unhappy. It is a multifactorial problem, but there are solutions to our unhappiness. In this article, I will provide a few suggestions that will allow us to return to those halcyon days when we enjoyed the practice of medicine. We can regain that same passion for medicine when we start our careers, and it allows us to take our eyes off the computer EMR and once again focus on the patient.

I think the road to happiness includes paths to financial security, prioritizing our own health, and achieving a favorable work-life balance.


Our finances


One of the most popular and conflicting statements is, "Money can't buy happiness." However, money is a factor that determines happiness worldwide, including for physicians.

Contrary to popular belief, doctors are not filthy rich. In fact, finances are a huge stressor for many physicians. Between decreasing reimbursements, rising overhead costs, and paying down student debt, it's easy to see why becoming a doctor isn't as financially favorable as it once was.


Being smart about your finances from the beginning of your medical career is essential.

With the average graduating medical student having a debt of $250K, it's common sense to want to pay it down as soon as possible. When a young physician begins their practice and makes more substantial payments on their loans, that debt is closer to $400,000.

Physicians, especially recently graduated or practicing physicians, often make the common mistake of thinking that they'll worry about finances and their debt later. That $250K debt starts accruing interest the moment they receive their diploma, and the interest on the loan starts accruing immediately after graduation.

For these reasons, it is necessary to understand financial basics. Unfortunately, our medical education systems do not prioritize business basics during our training. As a result, many doctors make mistakes that cost them a small fortune.


Importance of compounding


Compounding is a powerful investing concept that involves earning returns on both the original investment and the interest received on that investment. For compounding to work, you need to reinvest the principal plus the interest accrued.

Assume you are a physician in practice for a few years, and you begin by saving $1000 a month at 7% interest for twenty years.

To calculate the impact of compound interest, use the following formula:

A = P X (1 + r/n)t

Where:

A = the future value of the investment/account balance

P = the principal amount (the initial investment)

r = the annual interest rate (in decimal)

n = the number of times interest is compounded per period (usually a year)

t = the number of months

Assuming you're investing $1,000 monthly at an annual interest rate of 7% over 20 years (240 months), it would accumulate to $609,794. This result reflects the initial contributions and the additional wealth generated through compound interest over the investment period. A free calculator is available at investor.gov.

For physicians juggling demanding schedules, complex financial obligations, and long-term goals, regularly tracking finances can be difficult and daunting. However, advancements in technology have introduced budgeting apps as powerful tools to help physicians better manage their money.

Budgeting apps streamline tracking income, expenses, and investments, saving doctors valuable time. By automatically categorizing transactions and providing real-time updates, these apps make it easy to monitor spending and savings.

Using a budgeting app can help doctors manage their money, achieve long-term goals, and build a solid foundation for financial security.

I recommend beginning using a budgeting app to track your expenses. A complete list of free budgeting apps is available from capterra.com.

Your personal health


Our health and well-being should be the highest priority. We advise our patients to practice good health habits but don't take the same advice we give our patients. We need to prioritize our health because if we aren't healthy, nothing else matters, and we will never regain the happiness that we once had. This is like the advice regarding using the oxygen mask on an airplane. The adult passenger must use the oxygen mask first before putting the mask on a child.

I surveyed a group of male physicians and an aged-matched group of male attorneys. I asked each group about regular screening for cholesterol levels, colonoscopy, and PSA testing. It was of interest that lawyers participated in preventive health with greater frequency than physicians. How can we expect our patients to practice good health habits when their doctors don't set an example?


Suggestions for improving our physical health:


Start with small, achievable goals that fit your schedule, such as exercising for 15-20 minutes daily. We can incorporate more physical activity into our daily routine by taking the stairs instead of using the elevator.

Consider using a fitness app or wearables to track your progress and help you stay motivated. I recommend TechRadar, which lists top fitness apps with ratings, detailed features, compatibility, and pricing information.

PCMag provides a curated list of fitness apps along with their ratings, pros and cons, pricing, and detailed reviews. A website for home gym equipment is also available from pcmag.com.

My take-home message: Exercise is one of the first things we compromise on as we become busier. We must avoid sacrificing exercise to be busy. You can't take good care of patients unless you care for yourself. When you take care of yourself, you perform better and are better equipped to take care of patients.


Work-life balance


Physician burnout and unhappiness have reached epidemic levels. Few physicians disagree that our professional lives are often out of balance. Many of us had not even heard of the term burnout at the start of our careers. Now, more than 50% of physicians complain of one or more symptoms of the condition. Burnout can adversely affect patient care and is even causing doctors to retire earlier than they had originally planned.

Becoming a physician is an arduous journey, often taking more than 12 years after graduation from high school. Further, beyond seeing an increasing number of patients each day, many practices and health systems mandate same-day entry of detailed notes in the electronic medical record. That requirement has added a new term to the medical lexicon: pajama time. This is the time – typically one to two hours a day- that physicians devote to completing their medical records in the evening. This is time away from family, friends, and non-medical activities, such as hobbies, exercise, and relaxation. As physicians, we are seldom off duty. We are tethered to our mobile phones and make ourselves available to our patients 24/7. As a result, we don't take time to recharge our batteries.

In this blog, I cannot provide comprehensive solutions to the challenges of burnout. However, I do have one suggestion that will favorably impact your work-life balance: get unplugged. (This was described in Physician Practice in the December 15, 2023 issue) Disciplining yourself to not respond to emails, Facebook, Instagram, or TikTok videos for one day a week will allow you to move from imbalance to a better work-life balance.

Bottom Line: The amount of pressure and risk you take seeing patients for eight to ten minutes per session, the educational debt, and the fear of getting sued have created a climate of dissatisfaction and unhappiness in our profession. Physicians must cultivate healthy habits around sleep, exercise, nutrition, finances, and relationship building. A physician's career is fraught with challenges, stress, and anxiety. Doctors who do not prioritize healthy habits risk burnout and more dire health consequences, including increased mortality. Investing in relationships and fulfilling hobbies improves career performance and creates a favorable work-life balance. When doctors take care of themselves financially and physically, they perform better. They are also equipped to take care of their patients, and they put joy and satisfaction back into their medical practices. Ultimately, physicians prioritizing finances, health, and balance are healthy and financially secure when it is time to hang up the shingle.

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