Banner: Chronic disease accounts for 70% of deaths each year and 86% of our healthcare costs.

Journey to Value: Two Canoes, One River, New Mindset

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When I'm asked how the transition from volume to value-based health care is going, I joke that it's like navigating a river with Class 4 rapids while straddling two canoes. But the shift has seriously affected the way I think about patients.

When I practiced internal medicine in the early 1990s, for example, I might have had three or four diabetic patients who came in to see me regularly. And back then, I knew I was providing them with great care. I made sure their hemoglobin A1c tests were good, and I always did a foot exam and got their eyes tested.

quotation marksAccording to the Center for Disease Control and Prevention, chronic disease accounts for 70% of deaths each year and 86% of our healthcare costs.quotation marks

Unfortunately, I also had three or four diabetic patients who didn't keep their appointments. I’ll admit that I would feel almost relieved because I ended up using that time to catch up on my work load. Now that I work in population health, I think about those patients I missed back then, and I'm worried about all the patients our healthcare system still doesn't see today.

According to the Center for Disease Control and Prevention, chronic disease accounts for 70% of deaths each year and 86% of our healthcare costs. We need to retool everything we do in order to meet that challenge. Here are the four obstacles that I believe we need to overcome to keep physicians afloat and making progress.

  1. Prove it's real. Right now, most independent physicians are still paid largely on a fee-for-service basis, and even hospital-employed physicians are service-line oriented with their bonuses tied to things like keeping beds filled. We need to find new revenue streams based on value and pass those incentives onto providers so they see that there's something real behind all the talk.
  1. Get the information flowing. EHR and EMR systems produce massive amounts of information, but they are still organized around encounters and episodes. Most providers have patients who visit multiple hospitals, labs, radiology groups, physical therapy centers, etc. To coordinate care, we need to share all the information around a patient in a coherent way within the workflow.
  1. Get better at shared decisions. Better information flow and aligned incentives will help build trust and improve shared decisions around cost and quality. Providers must also learn how to determine the different levels of clinical risk in a population to have the best impact on care.
  1. Engage. Many patients are becoming more engaged in their own health, especially when it comes to their pocketbook. Consumer-directed health plans are on the rise, and a study by McKesson shows that 84% of patients want access to their full health record and more than 40% would switch doctors to get it. But are physicians honestly ready to engage with patients? We were trained one way, and we need to change the way we think, especially as transparency and consumer choice puts pressure on expectations.

Whether we can navigate those rapids remains to be seen. I think about a homeless person I saw recently with a below-the-knee amputation. He probably doesn't have a digital device or a patient portal, and yet he needs help. In a value-based environment, someone is going to be accountable for his care. The challenge is to somehow meet his needs, too.

We have a once-in-a-generation opportunity to fix this system.

Interested in more on successful strategies organizations are taking to adopt population health management in a value-based world? Read the blog post, Think Like a Payer: 10 Strategies for Successful Population Health Management and Cost Control, and watch the webinar replay for Focus Ahead on the Journey to Value-based Care: Trends and Tips for Success.

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About James Whitfill, M.D., Chief Medical Officer, Scottsdale Health Partners

James Whitfill, M.D., Chief Medical Officer, Scottsdale Health Partners

Dr. James Whitfill is currently the chief medical officer for Scottsdale Health Partners, a Clinically Integrated Network in Phoenix, Arizona. Dr. Whitfill received his AB from Princeton University, and his medical degree from the University of Pennsylvania. He completed his residency and chief residency in internal medicine at the Hospital of the University of Pennsylvania and a fellowship in Medical Informatics in the University Of Pennsylvania’s Department Of Medicine. At Scottsdale Health Partners, he has been a key part of the team which has delivered cost savings across multiple payer sources including commercial, Medicare ACO, direct to employer and Medicare Advantage plans. He currently serves as a clinical associate professor in the Departments of Internal Medicine and Bioinformatics at the University of Arizona College of Medicine-Phoenix. He frequently lecturers on the intersection of population health and information technology at the Biomedical Informatics graduate and undergraduate programs at Arizona State University. He enjoys running, skiing and camping with his wife and three children.