Guest Blog Series: Part 3: How The Nine C’s Help Accountable Providers Engage Accountable Consumers

With increasing responsibility for their own care, consumers are realizing the importance of their providers and care teams. And, in the age of the Affordable Care Act, more and more previously uninsured patients are realizing how vital it is to manage their own health care to keep costs manageable. In my previous two blogs, I discussed the importance of value-based contracts, and how incentives tied to physician performance create a culture of accountability for the entire care team, including those who already had insurance (including Medicare) and those who are now cycling into the health care system.

In this blog, I will discuss the final three C’s of the Lumeris Nine C’s framework, focusing on cost effectiveness, capacity expansion and career satisfaction. Given the amount of new covered members, these final three C’s are becoming increasingly important, especially as it relates to capacity expansion in physician offices, and keeping them satisfied with their career choice.

C7Cost effectiveness: Demonstrate sensitivity to affordability and effectiveness of care.PCPs can discuss with their patients the risks of unnecessary care, and offer cost options regarding appropriate medications, specialty care, screenings and diagnostic tests. The PCP can even encourage patients to shop for care together.

C8Capacity expansion: Reassure patients about your collaboration with clinical teams.The PCP should take the time to explain to patients the oversight of the care team, including email and telephone care, nurse practitioners and physician assistants, and that better care results from clinicians’ training, skills and passion for helping patients become and remain healthy.

Dr. Charles Willey, an accountable care internist, says, “Relationship is not medical. It is smiling, being friendly, and listening. I touch the patient on the shoulder and there is warmth and eye contact. The focus is your concern for what’s best for them, and then you weave in your own competence. My personal cell phone number is on the business card that I give every patient. If you take good care of them, they really don’t call you very much. Knowing you are available when they really need it is really powerful. Without credibility, we are nothing more than referral clerks.”

C9Career satisfaction: Nurture meaningful, caring relationships with patients and families. Long-term relationships with patients and their families produce physician satisfaction and patient satisfaction. This requires involving family members as allies in achieving patients’ health outcomes.

Tying it all Together

Accountable PCPs and accountable consumers achieve better outcomes. This is particularly important as we add millions of new members to the health care system. Physicians are taking on more burden, and incentivizing them to provide better care—via value-based contracts—and empowering the entire care team will have profound effects on increased quality at reduced cost. At the center of that equation is the consumer, who is and will continue to be increasingly responsible for his or her own care.

The Nine C’s help providers move from a volume- to a value-based model, and they center around the provider/patient relationship for care that is: Centered around the patient (first Contact); Comprehensive; Continuous (person-focused); Coordinated; Credible; Collaborative; Cost Effective; Capable (and has capacity); and Career Satisfying (to keep physicians in their occupation). To recap all Nine C’s:

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Experience Matters

Through Lumeris’ operation of a virtual integrated delivery network that serves 40,000 members, Essence Healthcare has become one of the highest-rated Medicare Advantage Prescription Drug plans in its region, earning a 4.5 Star-rating* for each of the past three years.

By deploying the Nine C’s, Lumeris has helped Essence Healthcare’s medical costs decrease to ~65 percent of total health care revenue (2013 before surplus distribution) before paying PCPs their share of the incentives. Over time, Essence Healthcare’s usage of this model has decreased potentially preventable readmissions by 40 percent compared to fee-for-service Medicare. Patients rated their ability to get needed care, and the quality of their care with 5 stars in each of the last three years. Over 97 percent of Essence Healthcare patients are seen annually, and more than 80 percent of networked providers consistently rate that they are satisfied with their collaborative payer partner.

*Plan performance star ratings are assessed each year and may change from one year to thenext.