Physician leaders share strategies at Payment Reform Summit

posted 10.05.11

With engaging speakers and thoughtful conversation, TAFP's Payment Reform Summit on Saturday, Oct. 1, presented a look at the current state of health care and how to reform the payment system to achieve high-quality, coordinated care in the future. The recurring theme was trading volume for value and how physicians can lead system reform.

Mike McCrady, M.D., M.B.A., vice president and medical director of clinical operations for Trinity Mother Frances Health System, provided the context of the meeting through three points: The country faces an unprecedented problem with the affordability of medical care as premiums rise faster than inflation and wages, and with millions uninsured or underinsured; payment reform is already underway in initiatives such as medical home pilots, physician alignment with hospitals, and integrated health care systems; and family physicians are the best candidates to lead transformation.

Next was Mark Laitos, M.D., immediate past president of the Colorado Medical Society, with “The Market-Based Imperative to Transform Medical Practice.” In simple terms, he said the current system has led to “conveyor belt medicine,” an “unrewarding” way to practice medicine that drives up cost.

He said reform is about changing from fee-for-service to fee-for-outcome using a triple aim: ensuring the health of the population is as good as it can be, that cost per capita is minimized, and that physicians and health care providers provide excellent care.

“We have watched a proud field get turned into something we don’t find valuable,” Laitos said. “We can do a better job. The world is ready to find out what that’s going to be. We [physicians] must lead the process; we can’t let others define it for us.”

Eduardo Sanchez, M.D., M.P.H., vice president and CMO of BlueCross BlueShield of Texas, spoke about the cost of health care from employers’ perspective. It’s about health-related productivity, he said. “Employers want better information and more value, and strategies to help reduce waste in health care spending and better engage employees in managing their health.”

Sanchez listed a few “necessary functionalities” as we move forward with reform: stakeholders must learn to collect and analyze data, promote population health and disease prevention, deliver evidence-based medicine, coordinate care to make the best use of physicians and non-physicians, and encourage value through the payment system.

Some strategies are in motion, such as the medical home and the Bridges to Excellence program, which offer physicians incentives to move forward with quality metrics. He also spoke about “virtual medical communities” on the horizon that could connect physicians in a platform for information exchange and management while allowing individual physicians to maintain their independence.

AAFP Board Chair Roland Goertz, M.D., M.B.A., presented thoughts on family physicians’ role in payment reform. Family physicians are essential for change to occur, he said, citing a 2008 fact that 62 percent of the 1.1 billion ambulatory care visits in the country were made to primary care delivery sites, and that family physicians saw nearly 25 percent, or 250 million, of these visits while comprising only 13 percent of total physicians. “The numbers are on our side. We must remember to use them,” Goertz said.

With AAFP members leading the adoption of the patient-centered medical home and health information technology, Goertz said that family physicians will survive this period of change. “I believe firmly that the future is bright for family medicine. The current system cannot continue. The value of primary care has been recognized and continues to be recognized. We have to engage and we have to lead.”

This provided the perfect segue to Christopher Crow, M.D., M.B.A., president of multispecialty practice Village Health Partners, who spoke about his experience taking best practices in other industries, tailoring them to medical practice, and providing high-quality, cost-effective care to show value to the patient and payer.

He has structured the practice around the idea of providing accessible, convenient, quality medical care to his patients, with each of his staff of 44 fulfilling a specific and appropriate role on the care team. And Crow uses data and analytics to continually improve costs, particularly in the largest cost driver in the system — hospital admissions.

Attendee Richard Young, M.D., of Fort Worth, reflected on the summit in a blog post, writing that he was impressed with Crow’s ability to effectively use his practice’s “IT infrastructure to promote its value to insurance companies and employers. They generate reports on the usual suspects — hemoglobin A1Cs, lipids, etc. — which raise the cost of health care.”

Young continues, “But where they really nailed it was that they have gone through great pains to show that their patients visit the ER less often and are hospitalized less often. In other words, they have figured out how to measure one of the most cost-saving realities of family medicine, our ability to use excellent judgment in treating sick people in our offices for whom it is safe to do so.”

The final event of the day was the expert panel with Melissa Gerdes, M.D., physician with the Methodist Mansfield Medical Center and assistant vice president and CMO of outpatient services and accountable care organization strategy; Gary Piefer, M.D., CMO of WellMed; and Greg Sheff, M.D., medical director of the ARC Medical Home Program. They spoke on their various successes with care coordination initiatives.

TAFP used social media platform Twitter as a live-feed platform during the day. View the Storify.com compilation of TAFP’s tweets here: http://storify.com/txfamilydocs/tafps-2011-payment-reform-summit.

The speakers’ PowerPoint presentations are available to download from the Payment Reform Summit page of TAFP’s website. Also, video recordings of each presentation will soon be available along with TAFP’s other online CME offerings at www.tafp.org/ professional-development/online-cme. Watch QuickInfo for their release.