Across the country, we are seeing massive changes in healthcare with new care-delivery models and alternative payment arrangements focused on better care. More payers are entering the provider space by acquiring providers, while providers are moving into the payer space and taking on more risk than ever before.
For primary care physicians (PCPs), this transition means that they have to move from a model in which they are no longer paid for volume to one in which they have to manage the health of the entire population in their care. How prepared are they for this? The reality is that medical schools haven’t figured out how to teach accountable care. I have a son who just graduated from medical school and I can tell you, he was not taught how to manage in this new world of healthcare delivery. In addition, for already established PCPs, change is hard, frightening and doesn’t just happen by saying “act like this.”
Last month, Lumeris invited physicians attending the CAPG Colloquium to join us for a luncheon and panel discussion on the evolution of healthcare and population health. We were delighted to be joined by John Doerr, Partner at Kleiner Perkins Caufield & Byers; Donald Crane, President and CEO of CAPG; and Dr. Walter Ettinger, University of Maryland Medical System SVP and Chief Medical Officer. I moderated the panel and found the discussion incredibly insightful; we have key parts of the discussion, such as John Doerr’s top three healthcare IT predictions, available at lumeris.com/CAPG. I had the opportunity to talk with several physicians at the luncheon and found they conceptually understand the changes that need to be made, but still have questions about how to transition to a new model of accountable care. The learning curve is steep. Frankly, our healthcare system cannot wait another 10 years to get new and established PCPs aligned on the delivery of accountable care.
What’s the Solution?
Through a lot of interviews and years of research, Lumeris has developed a unique – and more powerful – Accountable Primary Care Model. The approach includes the necessary behavior changes and workflows needed by PCPs and Accountable Care Teams (ACTs) to deliver accountable care.
In addition, we have a role-based playbook that helps the PCP and individual members of the ACT answer the questions: “What am I going to do differently tomorrow than I did today? How am I going to analyze a specific population? How am I going to structure the workflows for better patient visits?”
As an offshoot of our model, we also have developed a “boot camp,” where we bring PCPs new to this model into our Accountable Delivery System Institute and give them some practical skills and training to help them make this care delivery transition. It’s very action-oriented, and before they leave the boot camp, they have to commit to three to five things they’re going to do differently when they’re back in the office.
Beyond training, PCPs need good support and leadership, and so we work to mentor good clinical management and the appropriate use of technology. It’s important that PCPs and their ACT members feel connected – to each other, their patients and other specialists. This is where collaboration and cooperation is so vital to healthcare delivery.
What are the Results?
Before I get to the evidence, it’s important to note Lumeris’ mission is the achievement of the Triple Aim Plus One. The Triple Aim was developed by the Institute for Healthcare Improvement, and calls for simultaneously managing healthcare costs, improving the patient experience, and improving population health. However, our experience demonstrates that the key in achieving the first three aims is really engaging physicians and ACTs and changing the way they deliver care – the Plus One.
And now, here’s evidence. Lumeris’ long-standing client – Essence Healthcare – was recently awarded the highest rating available, 5-Stars, from the Centers for Medicare and Medicaid Services (CMS) for the quality of services it delivers to its Medicare Advantage members. This achievement is the best measure of quality we have today and it includes clinical quality, access to care and quality of service.
We have taken years to develop our Accountable Primary Care Model with Essence Healthcare, and now with the 5-Star rating, it means that we have perfected it while managing cost of care as well. And, we are positioned to extend this model to other healthcare delivery organizations interested in achieving similar results. Remember, though, that our model depends on the delivery of accountable care by the whole ACT, with the right incentives, training, behaviors, and workflows—that keep the patient at the center of care.
Contact us today at to learn more about how we can help you start the journey toward value-based care.