Better Primary Care, Specialist Collaboration Improves Care Delivery: Dr Michael Yim

Oncologists and primary care providers (PCPs) each play distinct roles in the management of patients with cancer, but collaboration between them can help improve the patient journey. At The American Journal of Managed Care^® (AJMC^®)'s Institute for Value Based Medicine® (IVBM) events, providers from across practices and specialties come together to discuss common topics in patient management and the potential for collaboration as efforts to implement value-based care continue.

Michael Yim, MD | Image credit: Northwest Healthcare

Stakeholders in oncology and primary care recently convened in Tucson, Arizona, for an AJMC IVBM event held in partnership with Arizona Oncology and centered on enhancing treatment through collaboration between PCPs and oncologists. Michael Yim, MD, board-certified family physician, medical director at Northwest Healthcare, and president of the Community Health Services Physician Leadership Council, took part in a panel discussion including oncologists and PCPs.

Yim spoke with AJMC to discuss takeaways from the meeting and the importance of collaboration between PCPs and specialists.

AJMC: What were some of your main takeaways from the meeting as a PCP?

Yim: We addressed my biggest concerns as a PCP. When I'm looking at referrals to specialists, I'm afraid of 2 things when I'm looking at cost for my ACO [accountable care organization]. First, how often will they be hospitalized? That's a big deal because every time one of your members gets hospitalized, that's going to affect shared savings heavily. And second, it’s a question of how much the medications—particularly with oncology and rheumatology—are going to cost, because some of those are just out in the ballpark, and you have no idea. It's a potential black hole, and it's one of those things where you want your specialists to do what they do, because you want the best for your patients—that's first—but at the same time, you're hoping that they'll be judicious. As I tell my patients all the time, we want to make sure you're getting something useful out of it, and we want to make sure that you're getting a good value for the money spent. I felt very confident leaving that conference, knowing that they're very good stewards.

AJMC: Can you speak to the role of a collaborative effort between PCPs and specialists, including oncologists, in ensuring patients receive the best possible care?

Yim: The meeting made me think about this a lot, because there's a real focus on what we can be doing as a team. It's not just an expectation of them—it's, “What are we doing to help manage this?” When you look at what their part and our part is, it really made me look at how we, as a group, approach things like hospice. You want your oncologists to really focus on giving the patient hope. I think that our side is kind of like the coach. We talked about being the quarterback of the team as PCPs, and I think that there's a point where, as a coach or a quarterback, you have to tell that one player, all right, this is not your play now. I think that we need to step up a little bit more maybe in that regard, because it's not just their responsibility to recognize when a patient has a less than 5% chance.

I think that made me really think a lot about the communication aspect and the collaboration aspect. These are things that we would have discussed in consultation back in the day, and these are things that we would have had face-to-face talks about either at a clinic or, more commonly, in the hospital. We would actually see each other and say, “Hey, I don't know if this is where the family wants to go,” or, “I don't know if they've got much of a benefit left here.” And we could have that conversation.

I think, with technology and other things driving us apart, you see more fragmentation there over time. During the meeting, we heard about how people want to connect and heard about seeing the act of picking up the phone to call your specialists as a sign of professionalism. I think that when I text or call my specialist and give them a heads up about where we're going, we all feel like we've put the patient first, and we all feel like we've served the patient better.

AJMC: How can the process of collaboration between PCPs and specialists be streamlined in the fast-paced workflows of recent years?

Yim: The biggest challenge with time is that sometimes, you end up having to use it during the patient visit, and that makes it so you've got a really small wedge. So, any way that you can set the stage and tee things up before you get there is really valuable. I think we try to do this in clinic all the time. When you actually have time in clinic, I always try to spend a little extra time with my patients building rapport, building connections, and learning about them, because I'm not going to have that someday. They're going to come in one day, and I'm going to have 5 minutes, and I'm really trying to make sure I've got everything that they need—but I can't spend the same amount with them, because someone else really needs it more. And that's part of that give and take throughout our whole schedule.

I think that when we have connections with our specialists, from a PCP standpoint, we've already made those connections, and it makes me want to refer to them more because I know that I don't have to call them and explain who I am or introduce myself and talk to them about why I'm calling them. I can just tell them, “Hey, we've got a mutual patient.” They're looking them up, and we're on the same page within seconds. I think that extra speed helps when you're ideally trying to call them to figure out how we want to manage this patient and what else they need from me before they see this patient.

You're taking it down from maybe a 5-minute call to a 2-minute call. But if we're talking 3 minutes of savings on 10 patients, that's a whole extra visit or 2 each day right there, and a 10% to 20% increase in your productivity, almost. That’s a big deal, so these things matter.

AJMC: Is there anything else you’d like to discuss?

Yim: I think what we now call value-based care used to just be called “good medicine.” So many of the facets of what we look at with value-based care circle back to the question of how we multiply the things that we had in old-fashioned good medicine to serve the large numbers of people we treat now using technology, statistics, numbers, and everything else. Otherwise, back in the day, it would be providers talking in a hospital, we'd be on call, and the patient would always have access to us. We'd be talking with the specialist all the time because we had the time to do that. That's what they want us to do, but how do we speed this up so that we can handle these masses of patients that are coming through?

I think that this meeting was a good way for us to examine all the different ways to be able to provide that same quality care in a sped-up system. It gave us a lot of extra tools, it helped us all look at what mattered, and how we could all contribute. I just really appreciated how much it made us all think about what our roles could be and what else we could do, as well as what was already being done.