The move to value-based care and population health is putting physicians in the driver's seat.
"The idea that accountability for quality and cost are closer to the point of care and therefore able to be impacted by physicians is a key part of the overall movement," Steve Wigginton, chief development officer of Evolent Health, said during a webinar hosted by Becker's Hospital Review.
Physicians are on the front lines in terms of impacting value creation and capture for hospitals and health systems, said Mr. Wigginton. However, many physicians feel their pulse weaken at the thought of value-based care.
Physicians are working in an increasingly difficult work environment. They are facing declining fee-for-service rates, reductions in Medicare bad debt payments and cuts to critical access and teaching hospitals. At the same time, they're experiencing increasing rates of burnout, less face time with patients and low patient satisfaction.
"When we think about winning the hearts and minds of physicians, we have to acknowledge first that it is a difficult task," Mr. Wigginton said.
Asking physicians to change the fundamentals of care delivery on top of an increasingly difficult work environment can create a skeptical, challenging audience. "Change, while generally good over time, is most often not great in its initial experience," Mr. Wigginton said.
Talking about the migration to value-based care with physicians is an opportunity to have a discussion on the quality of care, reimbursement structures and other possible sources of frustration. It is also a time to assess the tools, governance structures, data and rewards available to the medical team and practice.
Mr. Wigginton was joined on the webinar by Lisa Shah, MD, senior vice president of practice optimization for Evolent Health, who provided the following foundational tips and governance principles to drive this discussion with physicians, and James Porter, MD, CMO of Deaconess Health System in Evansville, Ind., who provided background on using these principles in action.
"For engagement strategies to be successful, systems must first establish a strong governance structure, and this governance structure needs to manage strategic and business priorities as well as population health initiatives for the system, giving physicians a unique voice and a seat at the table," Dr. Shah said.
To do this, she said health systems should create Physician Advisory Committees, both at the local and system levels. These PACs should include a range of physicians, from primary care to specialty and from employed to affiliated. This is an essential primer to implementing the following three foundational principles.
1. Increase efficiency by making the most of data and tools
Increasing efficiency might seem simple, but it is essential for a health system and the PAC to focus on efficiency and create workflows, according to Dr. Shah.
Many practices struggle with efficiency, Dr. Shah said. Multiple initiatives with multiple payers result in mountains of paperwork and documentation requirements for most practices. These initiatives may not be well-integrated into their workflow, causing frustration and fatigue across the board.
"What really matters is getting to better care and better value," Dr. Shah said. "The efficiency of giving actionable data at the point of care and being transparent with [physicians] is really important."
Providing physicians with monthly score cards on population health initiatives, quarterly compliance reports compared to peers and benchmarks, and semi-annual quality and cost efficiency dashboards can help physicians identify and prioritize areas for efficiency improvement.
Five-hospital Deaconess Health System has an accountable care organization with Encore Health Network called the OneCare Collaborative. To engage physicians in this network and promote the move to value-based care, Dr. Porter stressed grounding the idea in the triple aim. "If you don't have physician engagement as an overarching theme of the [value-based] initiative, it's really difficult to make progress," Dr. Porter said.
Approaching value-based initiatives from the viewpoint of what it can do for physicians — systematically identifying the most complex patients attributed to the practice — can make engagement much more attractive to them, according to Dr. Porter.
2. Reward top performance through incentive redesign
"If you build a foundational governance structure armed with efficient tools, technology and a care team that can provide the highest quality of care, physicians can be ready to be held accountable," Dr. Shah said.
In the early years of the migration to value-based care, activity incentives are helpful, according to Dr. Shah. They can help drive new behaviors. They should be simple, measurable and defensible. After physicians are comfortable with activity incentives, they can move to outcomes-based incentives and potentially profit-and-loss sharing options.
"In order to create measurable and defensible metrics for performance incentives and to shift behaviors toward accountable care, deal terms with payers and metric selection for performance need to be looked at from the provider point of view," Dr. Shah said.
If hospitals and health systems are leading these discussions without the PAC or physicians, it can ultimately have less impact for the providers, she said. With the involvement of the PAC or other physician governance structure, value-based contracts can designed in a way that is more mutually beneficial and financially sustainable.
"While they may not love the way they are reimbursed today, most physicians have grown a level of comfort with the RVU model," Dr. Porter said. "They know how that works and how their work translates into their income." Being able to bridge the gap of the familiar to the unfamiliar, it is critical to show physicians how incentives are directly tied to their work, he said.
3. Elevate patient care with technology and efficient workflows
This step is one of the most challenging and the most rewarding, Dr. Shah said. It's also the one that resonates most with physicians.
While the practice of improving patient care may be difficult, the concept behind it is not. "It's three things: the right tools, the right people and the right technology," she said.
This tools-people-technology solution refers to the right evidence-based clinical workflow, access to a full specialized care team, and a population health technology platform that enables the sharing of care notes, messages, care plans and continuous monitoring of a patient's health status.
"We certainly don't want to go out implying [physicians] provide poor quality," Dr. Porter said. "It's easy when you are talking about the things you would like to do to help a practice to put things in terms that, to a physician in their current paradigm, sound a lot like, 'You want me to do more for less money and you want me to do that because my quality is poor,'" Dr. Porter said. "Nothing could be further from the truth." Rather, he suggests framing this conversation as one about providing more resources to physicians so they can provide better care to patients.
With commitment, success will show, often in the words of the patients, Dr. Porter said.
"Patients who had experienced significant frustration — often not just with medical issues, but also with social and other complex, confounding factors — who were pretty frustrated with healthcare, frankly from our system before we started this program, were coming to us. Now they tell us they feel more attended to and cared for than ever before, and that's really rewarding for providers and for us," Dr. Porter said.
To learn more, view the full webinar on YouTube here. View archived webinars here.