Let’s Help Primary Care Doctors in the Movement to Value-Based Care

First, I’m not a doctor and make no claims to understanding their profession the way they do. I have not walked a mile in their shoes. But I have spent 25 years leading health plans including 10 years at the health insurer Aetna culminating as chairman and CEO. I have served as a Board member for Johnson & Johnson and Envision Healthcare (which operates both Envision and AMR). I have seen the health care system from many angles, including as a patient.

I remain deeply interested in the transformation of the American health care system to improve quality and contain costs. The United States is spending $3 trillion a year on health care, and 30% of that is considered waste by the Institutes of Medicine (IOM). Health care is forecast to be 19.9% of the U.S. GDP by 2022 by the Centers for Medicare and Medicaid Services (CMS).

Value-based care continues to be an area of emphasis, and more efforts are being made to transition doctors and hospitals to this payment structure. There is belief, and some evidence, that we may be able to substantially improve the quality of care provided to patients while reducing the total cost of care. To accomplish this, we must empower primary care physicians with the tools, technology, processes and appropriate financial incentives to help transform the system.

As consumers are being asked to pay more of the cost of health care services, they will increasingly demand more value and will also ask for more transparency and tools to determine the value they are receiving.

The Affordable Care Act (ACA) has legitimized the transformation of the health care system from activity to value-based outcomes. As the federal government gains greater involvement in health care, through the ACA or through Medicare and Medicaid, the emphasis on value-based payment is growing. In fact, the CMS expects to tie 50 percent of payments for traditional Medicare benefits to value-based payment models by 2018.

Many of these new actions are in support of hospital-based integrated delivery networks or systems. Significant support for primary care doctors who wish to remain independent will have to be created and expanded.

In a poll of family physicians by the American Academy of Family physicians, 1 in 3 are already actively pursuing value based payment models. Physicians often cited lack of time to implement the change as one of the largest obstacles to value-based care.

New approaches that can help physicians manage their costs of doing business, enable more work-life balance and most importantly improve their level of care to their patients can be a valued service.

One approach to accelerating the migration is to build on the California regulatory model for fully capitated primary care delivery. This model provides a platform and tool kit from which the appropriate tools for other local health care markets can be extracted, emulated, or modified. The model also provides a strong argument for partnering with independent primary care physicians to provide integrated support, technical systems and infrastructure, and deep knowledge of transparency and reporting requirements to help smaller practices survive as well as succeed in the necessary transition to value-based payments.

Physicians are on the front lines of health care. We can go a long way to transforming our health care system by partnering with them.