Despite a bumpy and ongoing transition, the healthcare industry has reached a tipping point when it comes to embracing population health and value-based care, according to presenters at this year's Medical Group Management Association (MGMA) conference in Nashville.
The host of new payment models that attempt to reward providers for paying attention to outcomes are all "just experiments," Atul Gawande, M.D., surgeon, author and Harvard professor, told attendees during his keynote address Monday morning. But their significance is apparent in the way medical residents and people entering the field of practice management choose where to work.
"We are losing more than half of our residents to places like Kaiser Permanente. People don't want to go to where they're just rewarded for volume," he said. "They want to be able to innovate and be recognized for it."
That recognition needn't be monetary, Gawande said; it's strong systematization that's attracting young talent.
Established physicians and practices are also rapidly (yet sometimes reluctantly) adopting disruptive innovations such as risk-based contracting, according to Gerard Filicko, senior vice president of clinical services for ACO-enabling company inHealth. Just two years ago, only 20 percent of physicians surveyed by the company said they participated in at least one alternative payment model, he told attendees of a breakout session about creating population-health infrastructure. Today, that figure has climbed to 60 percent, while 90 percent predict they'll join the risk-sharing ranks within the next two years.
But the shift can be difficult for physicians indoctrinated into the traditional culture of medicine, noted Filicko's co-presenter Stephen Cavalieri, M.D., chief medical officer for Central Virginia Health Network, which formed the MD Value Care ACO. "In the work life of physicians today, physicians are feeling disrespected," he said. "They're not understanding what they're being asked to do."
Physician engagement, therefore, represents the linchpin in any successful healthcare transformation, not the least of which include becoming an ACO and improving outcomes, Cavalieri said. And the best place to begin engagement is with communication. Practice leaders need to engage in face-to-face dialogue with physicians "as many times as it takes" to help them understand the nuts and bolts of their task, such as how to structure their data for reporting or use new systems or tools to close gaps in care.
When presenting quality reporting back to physicians, show them not just patient-level data but also physician-to-physician performance comparisons. "Physicians respond to competition," Cavalieri said. And because physicians like to "get the message right away," use a report card format to "show how they are doing and inspire them to take action right away," he said.
Finally, communication must be ongoing. "I personally have had over 25 practice meetings to get physicians iteratively involved in what's going on [with the ACO]," Filicko said.