The Future of Value-Based Care for Family Physicians

As family medicine physicians from across the country gather September 29 to October 3 for the American Academy of Family Physician’s Family Medicine Experience (FMX), we will be talking about one of the biggest buzzes in healthcare: the shift to value-based payment.

The conversation is moving beyond the fact of change to the pace of change acceleration. This year HHS announced its goal of having 30% of Medicare payments in alternative payment models (ie value-based care) by the end of 2016, and 50% by the end of 2018. Medicare is making this move because value-based care is improving patient outcomes. Increasing preventive medicine services, lowering hospitalizations and readmissions, and performing fewer unnecessary procedures means better medicine for both patients and their healthcare teams. The move to a value-based system is also saving money; in 2014, Medicare accountable care organizations (ACOs) generated more than $411 million in total savings. The private sector is not far behind, with a large coalition of health systems and insurers starting similar initiatives.

For primary care physicians, the implications of this shift are becoming clear. We understand the basic concept of value-based care: rewarding doctors for quality and outcomes instead of volume. And we are learning that value-based care empowers us to put patients’ health first.

A significant question remains: how can independent primary care doctors operate in this new environment? While many of us feel we have the skills to be strong champions in leading this change, we lack the large-scale tools, regulatory fluency, and dollars to do so without sacrificing the qualities that make our practices our own. Negotiating with an insurance company or digesting volumes of government regulations aren’t skills often taught in medical school. Spending time learning those things in the midst of adopting new technology systems, adhering to regulatory requirements, and overhauling the practice payment structure distracts physicians from doing the job we love most: taking care of our patients.

The solution for independent practices may come from an unexpected direction, through innovative partnerships that don’t require geographic colocation or practice-based infrastructure. Recently, my practice made the decision to partner with an organization that believes patients must be the center of value-based care, and that physicians are happiest and best utilized when providing that care to patients. Beginning January 1, 2016, I will be the medical director of a Kansas-based ACO with Aledade, Inc. This model moves the business, technological, administrative, and regulatory work of the ACO outside the practice walls. The partnership allows each party to focus on what they know best: the practice takes care of the patient population and Aledade takes care of the infrastructure. The success of each partner is dependent on the other, which aligns priorities and goals across the organization.

Value-based care is the future of healthcare. From independent practices to large systems, we must adopt innovative strategies to accelerate the pace of change. Our doctors need it, our patients deserve it and our healthcare system depends on it.