Primary care physicians reimbursed in a global capitation model perform better on key quality metrics than those in a fee-for-service model, a new study from UnitedHealth Group shows.
Under global capitation, primary care docs are paid a set amount per patient per month. UHG researchers analyzed data on more than 5 million UnitedHealthcare Medicare Advantage members across tens of thousands of physician practices and found higher rates of cancer screenings and indications that diabetes was better controlled by those in global capitation models.
For example, 80% of patients treated in the value-based arrangements were screened for breast cancer, compared to 74% of those in fee-for-service. More than 80% in global capitation were screened for colorectal cancer while 74% of fee-for-service patients were screened.
“When we have the time and luxury to focus on outcomes, we do,” Daniel Frank, M.D., chief medical officer at OptumCare, told Fierce Healthcare.
In addition, the study found that MA members treated in a global capitation arrangement had better blood sugar control levels, were more likely to be administered an eye exam and were provided functional status assessments and medication reviews more frequently.
Frank said that the blood sugar data is particularly impressive, as managing diabetes is a multifactorial challenge that includes tackling the social determinants of health and non-clinical factors such as food insecurity.
A patient may struggle with access to healthy food that’s critical to regulating their blood sugar levels or may be unable to find transportation to secure insulin or other medications, he said. Doctors operating under the gun in a fee-for-service model may not have the time necessary to address those needs.
“It's really about a holistic approach if you want to get it right,” Frank said.
Frank offered an example of this difference in his own practice. Before joining OptumCare, he was a primary care physician working in Florida. A patient came in with chest pain, which he suspected was related to anxiety.
Because the time allotted for visiting with patients was short, he referred the patient to a cardiologist for screenings, all of which came back normal. It was only after that protracted process that he was able to circle back to his initial gut sense that she was dealing with anxiety.
“I did it backwards because of the reality of what I had to do to manage and see patients in a large practice,” Frank said.
By comparison, after moving to work for OptumCare in Las Vegas, he was treating a man in his early 20s who was a smoker. When the patient came in for a follow-up after a hospital visit for an appendectomy, Frank coordinated a meeting with another patient in the clinic who was about to enter hospice care with terminal lung cancer.
That conversation was an effective tool that convinced the younger man to quit smoking, and it would not have been possible to coordinate something like that under fee-for-service, Frank said.
“Who could take the time to do that outside of a value-based practice?” he said.