Dr Debbie Zimmerman Discusses Accountable Primary Care

Accountable primary care is essential in lowering healthcare costs as a whole and making it care more accessible to patients. Debbie Zimmerman, MD, chief medical officer of Lumeris, spoke with The American Journal of Managed Care about how to improve primary care, how to get primary care physicians (PCPs) aligned on the delivery of accountable care, and how Lumeris is helping with these goals.

AJMC: What do you consider the benefits of accountable primary care in the US? What are its shortcomings?

Dr Debbie Zimmerman,: Accountable primary care is critical in achieving the Institute for Healthcare Improvement’s Triple Aim, which aims to attain better health outcomes with lower costs and improved patient satisfaction. We have seen this impact with up to 30% reductions in medical costs and improvement in quality while engaging consumers and providers.

We now know that physician engagement is critical in transforming the way primary care is delivered. We also know what drives physician engagement: payer value-based contracts; physician compensation models that reward value; panel density; strong clinical leadership and an organizational structure that encourages continuous improvement; enabling technology; provider-based care management; and workflow adoption.

The challenge is that the journey toward meeting all the key elements of success won’t happen overnight and the learning curve may be steep at times.

AJMC: What changes do you see occurring in today’s healthcare delivery models and alternative payment arrangements?

DZ: We are basically seeing every payer—government and commercial—talking about moving to value-based contracting. In fact, HHS has set a goal of tying 30% of traditional, or fee-for-service, Medicare payments to quality through alternative payment models by the end of 2016.

We see the commitment to change, and we see delivery models being tested to achieve success within those arrangements. We are learning that the alternative payment arrangements need to correlate with the capabilities of the provider group as they move across the risk continuum. There is no value to anybody putting a group in full risk if they are not capable of managing it. The models need to have balanced incentives (eg, cost, access, quality), transparency of performance and need to be a win-win for both payers and providers.

We see a wide range of care delivery models and have noticed that while some have been successful in a single market, like California, they are struggling to duplicate results in other markets. Everyone in the population health space is trying to learn from each other as we strive to define the right model for each population. One thing we do know is that we need to develop a team approach, where all members of the team practice to the top of their training.

AJMC: Do you believe that the US healthcare system should treat the alignment of their new primary care physicians in accountable care as a future goal or an immediate one, and why?

DZ: I believe there is no time like the present. Primary care has become increasingly complex and demanding. As primary care delivery migrates from a volume-based to a value-based model, providers and health systems must learn new strategies and apply proven best practices for delivering better care, improving the health of populations, and reducing per-capita costs. At Lumeris, we have a thorough understanding of what it takes for physicians to adopt accountable care. Physicians are starting to understand that accountable care can help them focus better on keeping patients healthy and new primary care physicians stand to find the practice of medicine more satisfying if they adopt accountable care. One additional advantage of adopting this model is more efficient delivery of primary care, which will help ensure we have the capacity necessary to meet the needs of our population in the future.

AJMC: How do you think these changes will affect PCPs and are they ready for these changes?

DZ: Many PCPs see accountable care as a positive change that is enabling them to have a more fulfilling practice and provide better value to their patients. There is evidence that PCPs across the country are ready for change. What we found is that the most successful PCPs are those who embrace the idea of accountable care and who adopt new tools, incentives, technology and information that enable accountable care. Those with a wait-and-see attitude are watching the early adopters and as soon as they observe their success, they will adopt accountable care too. Some may not yet have the right tool or partner, but they are ready for change.

The reality is that medical schools haven’t figured out how to teach accountable care. I have a son who just graduated from medical school and I can tell you, he was not taught how to manage in this new world of healthcare delivery. Change is hard, frightening and doesn’t just happen by saying “act like this.” But we see an interest in change and that is encouraging.

AJMC: How do you think these changes will affect the patient population?

DZ: These changes enable transparency of information and put consumers in direct, collaborative relationships with the physicians, health systems and payers who support them. The end result—consumers get better, more affordable, quality care. Working with their trusted advisor, their PCP, patients will receive the most appropriate care to avoid fragmented care and over utilization of services.

AJMC: Lumeris has developed an Accountable Primary Care Model. Can you describe what the model entails and how it differs from other models out there?

DZ: In order to enable the transformation from fee-for-service to value-based care, we have defined the critical elements of Accountable Primary Care and believe these to be unique in the industry.

We’ve developed a role based playbook based on what we call the Nine C’s (see sidebar), a prescriptive approach that organizations on the journey of adopting accountable care can use.

Once the Nine C’s Playbook is developed for a healthcare organization, we arrange for Accountable Care specialists to work with PCPs and their staff to implement the strategies. If practices are not performing, we provide additional clinical transformation assistance as well as a PCP Boot Camp through our Accountable Delivery System Institute.

Accountable Primary Care is key to achieving the Triple Aim (better health outcomes, lower costs, and patient satisfaction) as is having a collaborative payer and engaged consumer. Lumeris is the first company in the healthcare industry to have results validated by a third party (Aon Hewitt) that show a 37%reduction in costs, patient satisfaction improved by 45%,and physician satisfaction improved by 27%.

Lumeris’ approach guarantees clinical and financial outcomes, and helped its client—Essence Healthcare—achieve a 5-Star rating from CMS for the quality of services it delivers to its Medicare Advantage members.