The shift from the fee-for-service model to value-based care is happening across the U.S. healthcare system, but many physicians find themselves at a crossroads. On one hand, modern technology gives providers easy and constant access to patients, allowing them to care for their health on a continual basis outside of traditional office visits. With the right platform in place, it’s now easy to communicate with patients using personalized and automated text messages based on the person’s condition or situation. This can have a significantly positive impact on patient health, which should credit physicians under the tenets of value-based care since, in theory, they are to be compensated based on the health of their patients.
The Centers for Medicare & Medicaid Services (CMS), the largest healthcare payer in the U.S. with more than 90 million receiving benefits through Medicare, Medicaid and the State Children’s Health Insurance Program (SCHIP), has made a concerted effort to shift to value-based programs to compensate providers based on the quality, not quantity, of care they give patients.
As it stands, however, the vast majority of CMS payments continue to financially incentivize the volume of traditional medical visits, not adequately reimbursing for continual care outside of office visits. Value-based programs may be on the right track, but there is a significant disconnect between the speeds at which technology and health policy are advancing. Technology provides physicians an opportunity to deliver better and more constant care throughout a patient’s journey, but the bulk of CMS’ payment models are based on a single point in time.
When it comes to diabetic patients, for example, physicians might have continuous access to patients’ blood sugar values thanks to new wearable medical devices that upload patient data directly to the cloud, but they are only reimbursed based on the formal results of A1C blood tests, which are scheduled to take place every three months.
So while at-home medical devices—or even newer consumer devices with medical features such the Apple Watch—can provide patients with helpful information about their health, they’re not as useful as they could be. There needs to be a way for doctors to easily and continually receive access to this patient data for it to be impactful. Otherwise these devices simply create yet another data silo.
Technology does allow physicians to effectively treat patients between visits, however. For example, text messages with medical advice or short videos explaining a particular procedure are very useful for patients. It helps educate them about the condition they may have, and arming the patient with this knowledge makes in-person office visits much more effective. Further, this technology can be largely automated, making provider-patient communication faster and more efficient, allowing providers to do so at scale. While that is great for the patient and provider experience, it’s not necessarily supported under the current payment structures.
The problem is, the system isn’t yet set up in a way that compensates physicians for continual care. Providers are straddling two very different payment paradigms to keep their doors open—focusing on visit volume and focusing on quality performance . The question is, when will my performance and reimbursement be fully linked, and what steps can I reasonably take under a fee-for-service environment to prepare?
Holding patients accountable is key
The entire healthcare journey can be a challenge for patients, but at the same time patient input and accountability are vital in order to make this new value-based paradigm work. That’s entirely the point of effective healthcare—helping patients know what to do to improve their health, and when they need it most.
On one level it’s really about the healthcare industry getting with the times. There was heavy investment in web portals, but these are clunky, unintuitive and complicated to use. Many industries realize where the bulk of people spend most of their time: their phone. It’s now second nature for people to pull out their phone and request a ride, order a coffee or buy a movie ticket. We manage many aspects of our lives via our phones, so why not make it standard to also use our phones to manage the most important thing in our lives—our health?
If and when a value-based system is fully implemented, complete with metrics that compensate physicians throughout a patient’s health journey as opposed to paying at predetermined increments of time (such as every three months with A1C blood tests for diabetics), then patient accountability becomes even more important. It will be crucial for physicians to keep an open line of communication with patients to make sure they’re on the right track, as well as for patients to take the necessary steps they need to be healthy.
Why healthcare could (and should) be like buying a gym membership
If healthcare is moving away from fee-for-service model, then perhaps value-based care should look more like other subscriptions we have in our lives, such as gym memberships. Under this model patients would continue to pay each month, and physicians would be paid for delivering continuous patient care.
This type of shift would dramatically change the healthcare system as we know it, but everyone involved could be a winner. Most importantly, patients would benefit from taking a more active role in their own health throughout their care journey, improving their health literacy along the way.
Providers would win because they would be compensated for delivering continuous care while also improving the patient experience with more efficient forms of care delivery. And health plans would win as well—payers with more actively engaged patients save money because they manage healthier overall populations. CMS’s Primary Care First Model Options are a good first step to support the delivery of advanced primary care, and it would be great to see a similar model for specialists as well.
Today, the healthcare experience is often fragmented. Doctors typically try to decipher health history and other relevant information at the beginning of an appointment and then give advice in the remaining 10 or 15 minutes of the visit. Currently I am personally willing to look at a patient’s data a week ahead of time and start a messaging thread with them leading up to their appointment. I gauge if there is anything specific the patient wants to talk about, and once I’ve gathered their information I can give them my professional opinion. I’m willing to do that because it allows me to see patients quicker and improves the overall experience for patients, but I would be even more willing if I got paid for continuous patient care.
For now, however, we are left to navigate this gray area transition period between fee-for-service and value-based care. Fortunately, mobile technology that helps physicians communicate and treat patients on a more continual basis is a powerful tool that can help bridge the gap between these two very distinct payment models.
Medhavi Jogi is a physician, co-founder and managing partner at Houston Thyroid and Endocrine Specialists.
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