AHIP 2017: Executives explain why the road to payment reform runs through primary care

Alicia Berkemeyer, right, vice president of enterprise primary care and pharmacy programs for Arkansas Blue Cross and Blue Shield, speaks during the 2017 AHIP Institute & Expo on Thursday. (Leslie Small)

AUSTIN, Texas—While primary care doctors are far from the biggest culprits in terms of driving up healthcare costs, they are uniquely positioned to take the lead in payment reform efforts, two executives said Thursday at the AHIP Institute & Expo.

Primary care doctors do account for a small share of costs relative to specialists, said HealthPartners Health Plan Medical Director and Senior Vice President Charles Fazio, M.D. But they also wield considerable influence because they are often the touchpoint for a patient’s interaction with the entire healthcare system—including referrals to specialists.

Therefore, “we put our bets on primary care and giving them the tools and resources to control the costs of care,” said Alicia Berkemeyer, vice president of enterprise primary care and pharmacy programs for Arkansas Blue Cross and Blue Shield.

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In her work on Arkansas’ various focused payment reform initiatives, Berkemeyer has seen primary care doctors take leadership roles and embrace change, despite the challenges. The reason, she said, is “they want more control and they want more data.”

RELATED: AHRQ to study how primary care visits can reduce hospital readmissions

Through initiatives in like Arkansas Episodes of Care, primary care doctors get that control, as they serve as quarterback for patients and are responsible for ensuring their care is delivered at the appropriate cost and quality.

By standardizing treatment plans for a whole slew of conditions, such as heart failure and pneumonia, the state was able to lessen variation in prices for certain procedures and reduce unnecessary antibiotic use, among other gains, Berkemeyer said.

The state also boasts the Arkansas Patient-Centered Medical Home initiative and has 183 practices participating in the federal government’s Comprehensive Primary Care Plus program.

From her work on such ventures, Berkemeyer says she has learned several critical lessons. Provider leadership is key, as is integration of clinical data and having adequate training and resources to help practices succeed.

It’s also critical to be as closely aligned with as many payers as possible, she said. For payers, one key fact to remember is even though members may cycle out of health plans, the effort to get them healthy pays off if they come back.

“This is not a competitive area,” Berkemeyer said.

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