The fee-for-service healthcare payment model is broken, according to the CEO of a medical group. The better model, and the path to better patient care, he says, is value-based care.
Moving to value-based healthcare requires passion and investment in technology and staff, but the Hatfield Medical Group believes the move, which leads to better patient care, is worth it.
“I’ve been doing this for 24 years and I have seen the fee-for-service model,” said David Hatfield, D.O., president, and CEO of the medical group. “I’m not going to say I didn’t make a good living — but for me, I never felt like, ‘Wow, I’m giving quality care.’ I was giving quality care only from the aspect that patients had access to me because I would see a lot of them.”
The medical group, which comprises four primary care practices in Arizona, has spent the past five years moving from a primarily fee-for-service model, which Hatfield said is broken, to a value-based healthcare model.
It’s about bending the cost curve
“To us, population health means quality, compassionate care to every patient every day,” Hatfield said. “If you do quality, compassionate care to every patient every day, you’re going to bend the cost curve, which is what CMS is trying to do [with value-based healthcare] — bend the cost curve so they spend on medical doesn’t continue to rise … and eventually get so out of control that everybody throws up their hands and says we need a single payer.”
Hatfield is passionate about value-based healthcare because “it’s a better way to take care of the patients. Our providers have more time with the patients; they’re able to manage chronic disease conditions in a better fashion, we’re able to build a team around them. We strongly believe we need a team to treat a population of patients or treat a panel, so we have chronic care managers, we have our front office staff, we have our back office staff. Anybody who touches a patient understands what we’re trying to do when it comes to population health.”
Jim Schafer, the medical group’s population health strategist, said the move to value-based care requires “a lot of investment in technology. You have to train your staff to fully understand the functionality of [an] EHR, taking the time to understand quality metrics that are set by the [National Committee for Quality Assurance] to know who falls into a certain metric.”
“We analyze and track quality metrics in our [Greenway Prime Suite] EHR,” Schafer said, “and aggregate multiple sources of disparate claims data, pharmacy data, and other sources. … We had to make certain we optimized and leveraged the full functionality of our EHR — specifically, tracking data, capturing data and taking action on that data at the point of care.”
Once providers have data, payers will be on board
Insurance carriers are looking to boost value in health care, but won’t do so without data to prove the shift in care models works.
“Once [payers] see there are medical groups and providers who can improve healthcare outcomes and they have the data to support it,” Hatfield said, “[payers] are sure to adapt and allocate those dollars to those providers because they know ultimately they will reduce the per capita cost of health care for patients and improve the quality.”
The value-based healthcare model starts taking shape, Hatfield said, “when you get into shared savings contracts or full risk agreements, where you take on the risk of the population of the patients and have to indeed do population health.”
And that transition, he said, means managing patient health “from readmission to a hospital to ER diversion to pharmacy to making sure they’re getting preventive screening exams done.” Then, he said, “the health plan or the payer put it in your lap and says ‘Hey, here’s the money, you’re in charge of it, you get to spend it on claims; whatever is left over you get to keep.'”
“You have to manage that money, but you still have to do the right thing. You still have to show the data that says your patients’… blood pressure is controlled, they’re getting their colorectal cancer screening. We live in a data-driven world. Without that data to support what you’re doing, it’s nothing; it’s thin air.”
Take the challenge: Move to value-based care
The advent of EHRs, Hatfield said, helped spur the move toward value-based healthcare. Prior to EHRs, he said, “it would have been very difficult to try to put your finger on the pulse” of patient care.
“But now,” he said, “you can actually get into the weeds of how well are you taking care of your patients, how well your team is taking care of your patients, how well you are managing those chronic disease conditions that … are the ones that really cost the healthcare system a lot of money.”
David Hatfield, D.O.CEO, Hatfield Medical Group
“At the end of the day,” he said, “it’s being able to show in your electronic health record what you are doing to move the needle to improve the health of your patients.”
Despite the potential benefit to population health, “a lot of practices, aren’t ready for [value-based healthcare],” Schafer said. “They haven’t gone through the consolidation phase of making sure they fully understand IT functionality and their EHR functionality. They aren’t quite understanding all the data and the mandates from CMS, so there’s a struggle.”
Hatfield added that “the reason why a lot of people aren’t doing it is that its hard work, it requires daily monitoring and you have to be passionate about it.”
But he said healthcare providers need to take on the challenge of moving to value-based healthcare. “If you don’t change and move toward value-based care,” he said, “you will become obsolete.”