Value-based primary care should also include specialty care - MedCity News

The national movement toward value-based, accountable health care, focused on outcomes rather than volume of services, is one of the most significant developments in health policy of the past decade. Nowhere is this more critical than in primary care. In value-based delivery models, care is delivered through coordinated and multidisciplinary teams focused—and paid—to keep people healthy while better managing costly chronic diseases. This is in contrast to the prevailing fee-for-service care delivery model, where reactive episodic treatment of acute illness results in huge costs without better patient outcomes.

My experience caring for people in underserved areas of Cleveland tells me that providers must provide services beyond typical primary care—they must coordinate transportation, address housing and food insecurity, and address behavioral health issues and social isolation. While primary care providers are on the front lines of treating patients with costly chronic conditions such as heart failure, chronic obstructive pulmonary disease (COPD), diabetes and kidney disease, a new model is emerging that closely coordinates specialists while supporting end-to-end care each patient a care plan.

This common sense approach is, unfortunately, new to our healthcare system. For years, many patients were unable to access specialized care in a timely manner due to financial barriers, inability to find transportation, or because they were simply overwhelmed and did not know where to go for help. In one study, less than 35% attempts to refer to a specialist resulted in completed appointments.

Responsible value-based care providers prioritize timely coordination to ensure that teams not only make the right diagnoses, but also develop the right plans to keep patients healthy. Like national spending on primary care has declined, frontline providers have less time and resources and therefore refer increasing numbers of patients to specialists, resulting in fragmented care and higher overall costs. Between 2000 and 2019, the proportion of beneficiaries seeing five or more doctors a year increased from 18% to 30%, and the average number of specialist visits increased by 20%. according to the Centers for Medicare and Medicaid Services (CMS). Our system encourages more cooks in the care kitchen rather than streamlining teams of care providers to work together for the benefit of the patient.

However, there is a different way in which barriers to specialist access can be addressed through the integration of virtual specialist networks. On platforms like these, primary care providers connect electronically with doctors from over a hundred medical specialties, integrating their expertise into the patient’s care plan. Instead of waiting weeks or months for specialized care, patients can receive expert guidance in minutes. This type of harmonization leads to improved clinical outcomes, reduced hospitalizationsmore convenient patient experience and better quality of life for patients.

I recently cared for a patient with a history of heart problems and substance abuse problems. Also, like many of my patients, this man came to me with a significant amount of mistrust of the health care system; all he wanted was a primary care provider to treat him as a whole person. After an initial evaluation and taking his medical history, I was able to send targeted questions to specialists in cardiology, endocrinology, and psychiatry. The recommendations provided were integrated into his care plan, and the virtual platform saved him three separate office visits. Most importantly, this process unfolded in hours, not the weeks it would have taken in a traditional structure.

There is also an added bonus in this model for primary care providers. As any professional knows, while the experience of colleagues is critical, it’s also important that those you work with are right for the type of work you do. On the virtual specialty care platform my practice uses, primary care providers can rate the specialists they work with. This is important because our system must foster collaboration to support positive health outcomes across specialist-by-specialist layers with little communication back to primary care. By enabling sustained and collegial primary care/specialty collaboration, we also create deeper relationships between primary care teams, specialists and patients.

As the nation’s health care needs continue to evolve, we must continue our efforts to find innovative ways to meet them. The intentional use of specialty care coordination within value-based, accountable primary care structures are necessary tools in the drive to reward value and positive health outcomes relative to the volume of services provided.

Photo: Dmitrii_Guzhanin, Getty Images

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