Don’t destroy what works well in health care

Oct. 24, 2016 / By Kristine Daynes

What is the most effective mechanism in the U.S. to achieve the goals of health reform? Is it cutting-edge technology? Risk-based payment models? Affordable health insurance coverage for more people? No. These things definitely will help us accomplish better health care in America. But only as far as they support the patient-physician relationship. That is the most effective mechanism.

Americans trust their doctors, especially their primary care physicians (PCPs). In a recent study, nine out of ten adults agreed they were satisfied with their PCP. They said their PCP explains information so they can understand, is respectful, listens to them and knows their medical history. Say what you want of high costs and marginal patient outcomes. One thing that works well in the American healthcare system is the interaction between patients and their doctors.

Kyna Fong, PhD, co-founder and CEO of Elation Health, shared a similar message in a keynote address at the 3M Value-based Care Conference in Chicago last month. She noted that most value-based initiatives focus on plan and incentive design, data analytics and predictive modeling. These things need to strengthen the patient-physician relationship, not undermine it.

Dr. Fong pointed out the challenges of primary care. (Similar statistics can be found in The Physicians Foundation survey report and the Medscape Physician Compensation Report):

  • PCPs spend more than ten hours per week on administrative paperwork.
  • PCPs would need over seven hours per day to satisfy recommended preventive services for their attributed patient panel.
  • PCPs coordinate care with 229 other physicians.
  • PCPs are paid 40 percent less than specialists.
  • A practice spends about 800 hours and $40,000 per year to comply with quality reporting.

Value-base care should simplify the PCP’s job rather than complicate it. “The great thing about technology is the ability to make complex things simple,” Dr. Fong said. “It can place the patient in the appropriate population, set protocols, collect measures and prescribe actions. You don’t want a physician to have to think through the train of thought to do those things, but have the technology do it for them.”

She shared five guiding design principles to develop “thoughtful technology that is clinical first, patient-centric and embedded in the physician workflow”:

  1. Engage the physician in their workflow with timely feedback. Physicians have very little time to interact with the technology and it is more important for them to focus on clinical needs and patient relationships. The information must be available at the physician’s fingertips in less than 30 seconds to achieve what Dr. Fong calls “high consistent use.”
  2. Meet reporting needs without adding a burden to PCPs. Technology that automates quality reports makes the PCPs job easier. “It is unsustainable to expect PCPs to spend more time with technology. We should minimize the diligence and effort required to get paid.”
  3. Elevate the patient to an active, engaged member of the care team. “The patient is a powerful potential actor in the value-based care movement, if motivated.” Any solution needs to engage patients and make care quality clear to them. They should be encouraged to track and improve it. Every visit summary should be shared with the patient, as well as their clinical profile and health maintenance schedule. Finally, the data should be portable to other providers. It would save massive amounts of time for physicians and result in better patient awareness and education about their own health.
  4. Accommodate delivery of care by teams across settings. The team needs to be connected by a common patient record. Patient loyalty is to the best care, regardless of the IT system. Patient data needs to be able to follow them through the care system and travel faster.
  5. Make the technology affordable, whether for a multi-million dollar health system or a small physician practice. “Servers are cheaper and upgrade cycles are more frequent. We are past the point that the delivery of care needs to be constrained by technology. We don’t need to put all physicians under the same roof just for the sake of technology.”

In addition to thoughtful technology, an effective value-based care program requires thoughtful design. Dr. Fong noted that some programs can be counter-productive. For example, patients can be overwhelmed by outreach from the insurance company, other doctors, pharmacies and treatment facilities. “When a patient hears from the insurance company, they wonder whether their premium is going up next year. A response that isn’t necessarily the goal,” said Dr. Fong.

“What we have found most effective is engaging the physician to deliver one message,” she said. “The more engaged the physician, the more engaged the patient becomes. That is where their relationship is, where the trust is. They listen to a message delivered from the physician in a coordinated, collaborative way.”

High-deductible health plans in particular require more thoughtful design. Many insurance companies introduced high-deductible health plans as a way to get consumers engaged in making health decisions. Dr. Fong said the higher out-of-pocket costs need to be coupled with education. “What does a patient do when they see a treatment that is very expensive? They don’t want to do it,” she said.

A patient’s decisions shouldn’t be based on cost alone, but on efficacy and value. Patients depend on their physician to explain the efficacy of different options and help them evaluate them in light of their personal health goals.

The PCP as a competent trusted advisor is critical to value-based care. “A patient cannot make all of the decisions as a consumer. It is challenging,” said Dr. Fong. “But it is best and most effective when you leverage strong patient-physician relationships to drive the decisions.”

Kristine Daynes is marketing manager for payer and regulatory markets at 3M Health Information Systems.