Transitioning from Volume to Value – Cutting Edge Population Management

Lisa P. Shock, MHS, PA-C

Accepting responsibility to care for a given patient population with chronic disease (diabetes for example) involves a transformational shift from counting numbers of patients served to managing a population with a given chronic condition.   As teams begin working to improve the quality of care, efficiency and patient service to such a designated population, a shift in care delivery is occurring.   Accountable Care Organizations (ACOS) are developing, organizing, and experimenting with different ways to adjust reimbursement in primary care to reward improvements in quality, efficiency and care coordination.

Many successful Accountable Care Organization (ACO) models are embracing a shift from volume-based reimbursement to value based reimbursement and the formation of population health management hubs.  With the development of these new structured organizations, PAs and NPs will also act as extenders to support the primary care physician within the medical home model.

Consumers are more actively shopping for health care.  Transparency is being demanded to enable comparison-shopping. The 2011 US and Global Survey of Health Care Consumers performed by Deloitte showed that consumers remain largely confused about the health care system although they were highly opinionated about their interactions with doctors, hospitals, health insurers, and in their views of prescription drugs.  As a result, they concluded that consumers judge the U.S. health care system more based on their prior personal experience rather than by a systemic view, perhaps due to its magnitude and complexity.

Patient satisfaction is becoming more central to patient care, especially in the primary care sector.  With the advent of social media and online reputation management, patients are increasingly rating and comparing all providers on their health care delivery team.  Often customer service oriented metrics including wait times, provider responsiveness and communication of test results in a timely fashion define a successful patient interaction experience.

Benefits for population management are based on a primary hypothesis for quality.  Third party payors are incentivizing primary care providers to meet quality metrics through improved reimbursement programs such as the Blue Cross Blue Shield Blue Quality Physician Program.  (BQPP)

Improved reimbursement models also plan to utilize methodologies such as bundled payments to incentivize quality.  Under a system of bundled payments, reimbursement for multiple providers is bundled into a single, comprehensive payment that covers all of the services involved in the patient’s care. The goal of the bundled payment approach is to improve population health, improve the patient care experience, and reduce overall health care costs.

Health reform efforts are targeting development of improved bundled payment systems.  The Accountable Care Act calls for establishing a national pilot program on payment bundling for Medicare program by 2013 and for a Medicaid bundling demonstration program by 2012.  The new Center for Medicare and Medicaid Innovation (CMI) will recruit and enroll patients into a voluntary, five-year pilot program that will test bundled payments. These pilots may include hospitals, Long Term Care facilities, inpatient rehabilitation facilities, physician groups, skilled nursing centers and home health agencies.  They will address episodes of care that begins three days prior to a hospitalization and span up to 30 days post-discharge. The trial pilot will test improved coordination, quality, and efficiency of care services around a given hospitalization for a patient with one or more of eight medical conditions to be determined and selected by the Secretary of Health and Human Services.

By integrating the care delivery system and restructuring the delivery of primary care services across settings from outpatient to hospital, populations and conditions may be managed more efficiently.  A team approach to care delivery will help to improve patient satisfaction and improve quality care for chronic diseases.  Transformation of care delivery teams and utilization of an interprofessional team approach will then lead to improved outcomes overall for patients.

 

References: 

2011 U.S. and Global Survey of Health Care Consumers

http://www.deloitte.com/us/2011consumerism

healthSource: United States Department of Veteran Affairs, VA Healthcare VISN 4, Patient-Centered Medical Homes: Patient-Aligned Care Teams, 2010; Oliver Wyman Analysis

Bundled Payment – AHA Research Synthesis Report, American Hospital Association Committee on Research, May 2010.  PDF

 

About the Author: 

Lisa P. Shock, MHS, PA-C, is a seasoned PA who has managed chronic diseases in primary care since her student days at the Duke PA program in the late 90s. She enjoys part time clinical primary care practice and is the President and CEO of Utilization Solutions in Healthcare – a specialty consultant company for physician practices and hospitals, offering a wide range of services to help implement and improve upon the utilization of PAs in the health care system.  Contact her with questions at lisa@pushpa.biz

 

 

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