After an examination, physicians will recommend a care plan – but what if the patients visit numerous doctors for different illnesses? Who is coordinating their care? This is an especially important question for the senior population. About two-thirds of Medicare beneficiaries have two or more chronic conditions, such as diabetes, heart disease or kidney disease. Their care is often fragmented. As Sean Cavanaugh, deputy administrator at the Centers for Medicare and Medicaid Services said, “We all need care coordination. Medicare patients need it more than ever.”
These seniors often find themselves dealing with a complex system of hospitals, doctors and health plans and they often fall though the gaps in care. Additionally, chronically ill patients who receive more fragmented, less coordinated care – or whose care patterns were spread across a higher number of providers – were more likely to receive lower quality care at higher costs, according to a 2015 study of more than 506,000 chronically ill patients.
This is a problem.
According to a 2016 survey, U.S. physicians are slow to adopt value-based care models because the financial incentives to participate have not changed, and the tools to assist the transition vary greatly. While the barriers to coordinated care may seem difficult to overcome, they can be eradicated through clear and consistent communication between physicians and insurers.
Insurers can facilitate the path to value-based care for more physicians by understanding the challenges that physicians face and working to remove those barriers with their input. Thus, insurers can help physicians stay independent and provide the resources they need to focus on what should be the most important metric in healthcare today and every day: people’s health. When all physicians, hospital administrators, health IT vendors, payers and others in the healthcare system work together, they can deliver better benefits, better care and better patient outcomes for more people than they could achieve alone.
How does this work in practice?
Take Alignment Healthcare’s partnership with AllCare, for example. AllCare is one of the largest independent physician association (IPA) in California, representing physicians in Merced, San Joaquin, and Stanislaus counties. Alignment provides its partners with a complete framework for a value-based care model – including an advanced clinical model, robust IT and enablement systems, extensive risk experience and capital. When we began our partnership, we were serving 800 Medicare Advantage members using AllCare in one county. In the course of two years, we expanded that number to more than 12,000 in two counties.
Statistics and patient metrics justified the movement to value-based care.
Alignment designed a competitive benefits package specifically for this membership, and our clinical teams work hand-in-hand to train AllCare clinicians on Alignment’s unique care model as needed. Alignment helped AllCare establish a hospitalist program and a remote monitoring program, and we operate three co-branded clinics in those counties.
The metrics and care alerts that these programs generate provide AllCare clinicians with a better understanding of how to care for their patient population. Post-discharge visits by AllCare’s hospitalists include medication reconciliations to keep members healthy and prevent them from having to go back to the hospital. Our shared fiscal responsibility strengthens our collaboration and allows AllCare’s physicians to play a major role in deciding what medical care is best for their patients.
Our partnership allows for increased revenue, cost reduction and improved health outcomes. More importantly, it allows for coordinated, efficient care for our patients who need it the most. If more providers – empowered by collaborative partnerships – move toward a value-based model, we as an industry can further prioritize our collective mission to keep patients healthy.
Dawn Maroney is markets president for Alignment Healthcare, a company redefining the business of healthcare by shifting the focus from payments to people. Matt Coury is CEO of AllCare, a physician organization represented by over 1,000 private practice physicians in Merced, San Joaquin, and Stanislaus counties. Alignment Healthcare and AllCare work together to cut costs and improve lives by unraveling the inefficiencies of the current system to drive patients, providers and payers toward a common goal of wellness
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