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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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