Healthier outcomes: Keeping patients at the center of care

Early in my career, I treated a young patient with uncontrollable asthma. Instead of being in school or playing sports with his friends and classmates, he was often in the hospital. My only goal was for this patient to get his asthma under control so he could live the life he and his parents imagined. Thankfully, a chance run-in fifteen years later confirmed that we were successful. All those years after the last time I saw the patient in the clinic, I saw him in the bleachers at a high school football game. He shared with me about his job and all that he’d gone on to accomplish in his life. 

It was a proud moment, but this story is not unique to me. Every clinician will have a version of it. So, why is it important? It is a reminder that those conversations — the knowledge that we have helped someone to lead a healthy life — are why we do what we do. 

While value-based care has been a part of the healthcare landscape for several decades, the model has not achieved widespread implementation. Where it has, it has not produced substantial cost savings, or high-quality care, for the most part. Frankly, value-based care is not aligned with the intrinsic motivation of the physician. I got into pediatrics to change the lives of children and families, certainly not to make money or to generate financial value for the places where I was working. Some of the disconnect for me personally is in the name value-based care. No one in medicine would want to associate taking care of their patient with an estimation of that patient's monetary worth. It is demeaning both to the patient, and most importantly right now to the caregiver, to put a dollar value on a patient. It's why I am advocating instead for healthy-based care. 

No matter what we call it, we must change the economics of healthcare in a way that allows doctors to care holistically for patients and places trust in physicians that they know the best way to help their patient become and stay healthy. 

As the chief executive officer at UNC Health, I look to some of our success stories to see the benefit of models that put patients' health first.  UNC Health Alliance, our clinically integrated network and population health services division, partnered with local payers to focus on delivering outstanding outcomes. In 2021, the Alliance provided around 150,000 crucial preventive services, including cancer screenings, hypertension control and childhood immunizations. These are services that we know can keep patients healthy. 

The Alliance earned a 100% quality score for the second consecutive year and generated cost savings which were then reinvested back into the network to expand primary care and population health infrastructure. By focusing on health outcomes, value was realized and then placed back into the system to expand our capabilities. For example, supporting new collaborative care models in behavioral health. 

The way that we practice medicine now is fundamentally different than it was even five years ago. A primary care physician where I work at UNC is now on a care team with a nurse, a nutritionist and a social worker. They see patients both in the clinic and virtually. But for many practices, this new way of working is reimbursed through the old model. Physicians are in the middle of a push and pull from fee-for-service and value- or healthy-based models. They are seeing more patients and communicating constantly via the electronic health record. They are not appropriately reimbursed for this time in a system that favors more visits, more testing and that often promotes inefficiency. 

We must prioritize preventive services; counseling and education; clinical care outside of the hospital; (among other ways to care for patients), as well as a team approach to helping someone stay healthy or become healthy. Reimbursement is not keeping up with the changing ways that we care for patients. We know physicians will be resistant to changing their ways if they are not properly compensated for their time. In a healthy-based model, a primary care office could see several times more patients per day, with the physician only focusing on the 8-10 most complex. This is the way physicians desire to practice. It's what connects them back to the calling that drew them to this awesome profession.

But the reality is that neither health systems nor providers can succeed without partnership and support from state and federal government stakeholders. And private sector payers can't realize the value of this new model without fully moving away from fee-for-service. The wave of change won't happen overnight, but the pandemic showed us that we can make big changes quickly. Given the current struggles we face in healthcare, this shift to talking about and focusing on healthy-based care is vital enough to warrant all stakeholders' attention.

Years have passed since that football game. From my current seat as the CEO of an academic health system, I think about two things each day: our patients and my teammates. The current model is not serving either. I hope we are making a positive impact here in North Carolina, but this requires systemic change. Patients cannot improve their health without the support and guidance from their providers. Likewise, payment models cannot be successful without a partnership between physicians and payers. A focus on finances alone has not improved health, delivered value or lowered cost. Moving forward, we must equip providers and practices of all sizes with the tools and support they need to deliver health to those they serve.

Wesley Burks, MD, is CEO at Chapel Hill, N.C.-based UNC Health.

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