Fee-for-services payment models in the primary care ecosystem are doing a poor job of keeping Americans healthy and reducing the nation’s massive amount of healthcare spending, two CEOs of primary care companies said during a Thursday webinar hosted by HLTH.
The two leaders were Christopher Crow, CEO of Texas-based primary care network Catalyst Health Group, and Kyna Fong, CEO of Elation Health, a company that sells its EHR and other technology solutions to primary care providers. They both argued that stakeholders in the primary care space need to come together to introduce and support more value-based care arrangements.
In Crow’s view, fee-for-service care is like getting your car’s oil changed — you get this service every once and a while and then you forget about it until you need it again. This type of transactional care might make sense for something like a knee replacement or an emergency room visit after a car accident, but these one-off appointments aren’t ideal for maintaining a person’s health over the course of their lives, he explained.
Instead of the oil change approach, Crow thinks primary care would be better off using a model that looked more like a Netflix subscription. Just like viewers pay monthly to watch content whenever they’d like, it would be ideal for patients to pay somewhat of a fixed fee to conveniently access their care team at any time or place. And similarly to Netflix’s suggestion algorithms, care should also be personalized to meet individuals’ needs, Crow said.
“The value of primary care compounds over time. Just like your interest rates compound, relationships compound over time because trust is built in there. Therefore behavioral economics can come into play in different ways with those relationships. And so this idea of paying with a subscription model over time for that value compounding makes a lot more sense for how care is delivered at the primary care level,” he declared.
If the U.S. primary care system wants to put patients first, it needs to establish more care models that offer treatment to people whenever and wherever they need it and less that incentivize transactional episodes of care, Crow added.
The care model for which Crow is advocating would not only meet patients’ needs for convenience and accessibility, but it would also improve health outcomes, Fong said.
“In a subscription model, that relationship is ongoing — a visit is going to happen again. But traditionally, a lot of the interactions with primary care have patients saying ‘I saw somebody. Am I going to see them again? Am I going to see them next year? Who knows, maybe.’ I think that limits potential,” she explained.
Fong pointed out that a lot of investment dollars, both from the government and venture capitalists, are being funneled into value-based primary care models that treat high-cost populations, especially those covered by Medicare. This shift came because costs were soaring — rising costs correlate “to really poor and unfortunate health outcomes and health events that can be prevented if they were identified upstream,” she pointed out.
In addition to more of this investment, primary care providers also need the right technology in order to help their patients thrive in value-based care arrangements. Much of today’s healthcare technology is “at odds” with supporting value-based care and high-quality care, Fong declared.
“The EHR systems were not incentivized to do that. They were incentivized to pump out bills, and create documentation to support bills,” she said.
Rather than prioritizing billable interactions, healthcare technology should try to involve patients more in their care plan and ensure they are on the same page as their providers, Fong argued. This two-way communication returns power to the patient and ensures they have a more active voice in their health.
After most primary care visits, the physician is left unaware of how their patient went about their follow-up care at home, Fong pointed out. Doctors don’t really know if their patients went to the pharmacy to fill their prescription, or if they’re still taking that medication as instructed. With more bidirectional conversation between providers and patients, some of these problems could be solved, she said.
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