In the Future, Doctors Will be Paid to Keep You Healthy

Health care is changing. Of course, everyone knows that. It changes all the time. But this time, there’s a fundamental shift going on in the way the United States evaluates and pays for health care. 

Historically, health care providers have been reimbursed through a fee-for-service model. Basically, that model has given physicians and organizations incentives to “do more.” The more tests ordered, the more patients seen, the more procedures done – the more money made.

Now, enter value-based care. One of the biggest buzz phrases in health care these days, value-based care is emerging as a “solution to rising health care costs, clinical inefficiency and duplication of services, and to make it easier for people to get the care they need,” according to Aetna, a large insurance company.

With value-based care, doctors and hospitals are paid to keep people healthy. The idea is to make health care proactive, instead of reactive – preventing problems before they start. 

This new way of doing business started after the passage something called MACRA, or the Medicare Access and CHIP Reauthorization Act, in 2015. The extensive (read: long) piece of legislation – the final rules are nearly 2,400 pages long – established new ways to pay physicians caring for Medicare beneficiaries. As the Network for Regional Health Care Improvement describes MACRA, “it is comprehensive legislation that has the potential to significantly restructure U.S. health care.”

Even though MACRA rules apply to Medicare Part B payments, it’s expected that the law will drive change for all patients and encourage broad-based transparency and accountability, according to the NRHI. Most physicians and health-plan executives believe that the transition to value-based care will continue regardless of what happens with the Affordable Care Act and Republican proposals to change it, according to a survey sponsored by Quest Diagnostics and Inovalon, a health technology company.

“Everything down the road in reimbursement is going to be based on quality and outcomes,” says Dr. Joseph Schlecht, a primary care physician in Jenks, Okla., who has been tracking and reporting quality data for more than a decade. Schlecht stresses that the shift away from fee-for-service is not just about saving money for Medicare or increasing profits for insurance companies.  Patients, he says, benefit when value-based care is done correctly. 

Transitioning from a volume-based to a value-based system has been slow, however. A 2016 survey of executives at health provider organizations indicated that only 27 percent had completed pilot programs or were at some stage of rollout. Organizations such as Kaiser Permanente, Geisinger Health System and the Cleveland Clinic have been experimenting with value-based models. 

Value-based programs have many moving parts, which means impacts beyond how services are paid for. To effectively manage patient care, says the NRHI, providers will have to rely on good accurate data – often from multiple delivery systems. 

That means, NRHI adds, “that the technology and data infrastructure will need to change.”

That’s where electronic health records come in.

More and more, physicians and hospitals are moving to new electronic systems to help them keep tabs on patients rather than relying on the paper systems of old. Electronic records can be hugely beneficial: They keep track of a patient’s health records in one place, but even more so, they can help multiple doctors and hospitals track a patient’s history. The problem sometimes is, however, that not everyone has access to those records.

As value-based care models evolve and improve, it opens up the door to health information exchanges (HIEs). These exchanges make sharing health records across the continuum of health care delivery secure, simple and accessible. Companies such as Simply Connect, a Minnesota-based HIE, use ground-breaking technology to connect health care providers, including hospitals, physicians, pharmacies and more.

Consolidating records in one spot allows everyone to be working from the same page – and that helps improve the speed, quality, safety and cost of patient care.

There are hundreds of health information exchanges out there, many of which are geographically specific. But the NRHI says that many providers are reliant on records systems that are incompatible with those of competing systems. Eventually, MACRA timelines will require all health care providers to be reporting certain data, which means institutions will need to find the best ways to go about that in order to serve their patients.

As a national exchange, Simply Connect can do that, says Nate Tyler, the company’s chief operating officer. Simply Connect’s platform is able to connect easily with multiple records systems already in place.

“Right now, people don’t get the value they hope out of health information exchanges,” Tyler says. “We can help identify values up front, and set them up to a path to success.”

An HIE can be used to track patients from the moment they enter the hospital to when they leave it, whether it be to a rehabilitation facility or to their home to receive home-bound care. If everyone is on board, different providers along the way can enter information in the records so that everyone can see them – including the patients themselves. HIEs such as SimplyConnect can even track pharmacy records and let physicians know whether patients are refilling medications. Care coordinators can help teams of health care professionals communicate with each other.

The ideal result, according to the Cleveland Clinic, “is fewer readmissions and less frequent hospitalizations and trips to the ER.”

There is still, however, much to be done. The Quest survey, conducted this year for the second year in a row, found that fewer than half of the physicians surveyed were happy with the functionality of the electronic health record systems they were using. At the same time, more than 70 percent of the physicians said they’d spend more time using technology if the electronic records systems could yield insights unique to their patients.

And nearly 90 percent of the physicians said they’d likely use a tool that provides on-demand, patient-specific data to identify gaps in quality, risk and utilization, as well as medical history insights delivered within the clinical workflow in real time.

The transition to value-based care, and the data reporting and funding mechanisms that go along with it, can be challenging for doctors, but there are professional organizations that have formed to help doctors navigate through it. Dr. Robert Dean Jr., a critical care physician and senior vice president at Vizient, a Michiganbased health care performance improvement company, says that as doctors adopt value-based protocols, the results will be positive for both them and their patients.

“We see many clinicians feel like they are taking better care of their patients,” Dean said in Medical Economics. “We are seeing an increase in the improvement of burnout and more joy in their work. I think we need to get through this transition, but they are all things that will make patient care and the practice of medicine better.”

  • Tina Fonteneau

    Great article! There are many changes in healthcare happening quickly. Articles like this one help educate professionals and patients on what to expect.

About the author

Kim O'Brien Root

Kim O'Brien Root has been a reporter for 20 years previously working for the Daily Press and The Roanoke Times. She's been a freelance journalist since 2010, balancing writing with being a chronic volunteer. She lives in Hampton with her husband, a fellow journalist, two children and a dog.