How to incorporate primary care transformation into a refresh of the health system strategic plan

While the concept of value-based care has been around for some time, successful implementation is still challenging for many primary care providers. The solution revolves around extending patient-focused services beyond the office visit.

At a session sponsored by UpStream at the Becker's Virtual CEO + CFO Roundtable, Valinda Rutledge, Chief Corporate Affairs Officer at UpStream, facilitated a discussion about challenges associated with delivering value-based care and how the right partnerships can benefit both provider and patient. Panelists from UpStream were:

  • Sanjay Doddamani, MD, Chief Executive Officer
  • Nathan Hemberg, Pharm.D., Chief Practice Officer
  • Mark Reardon, MD, Chief Quality Officer

Four key takeaways were:

  1. Despite clinical advancements, many providers are still struggling with the basics of value-based care. "American healthcare is going through a midlife crisis," Dr. Doddamani said. "We've had tremendous innovation in specialty care and advanced surgeries, but we're still struggling with very fundamental issues in health equity, adequately resourcing the care delivery system and tremendous anxiety and fear in moving into a total cost of care model." He emphasized the critical need for change as the population ages. "We're at the confluence of a perfect storm; the delivery system is facing a tremendous amount of pressure to meet the needs of older, sicker patients."
  2. Partnerships between PCPs and those who can deliver upstream solutions are the key to value-based care success. According to Dr. Reardon, building longitudinal engagement with patients drives quality gap closures, improvements in total cost of care and higher patient satisfaction. "Those longitudinal touch points need to be delivered by a consistent team that is supporting engaged primary care physicians," he said. "That has the opportunity to drive transformational outcomes, solidifying the role of health systems in this transformation to value-based care."

Partnerships with expert solutions providers mean that physicians can be unburdened from repetitive tasks that are more efficiently delivered by the partner organization. For example, UpStream provides a clinical pharmacist who works closely with the physician practice. "That clinical pharmacist is supported by other health professionals, such as nurses and healthcare concierges," Dr. Reardon said. "When we have that standardized engagement after a primary care physician encounter, we deepen the relationship between the health system, the primary care physician and the patient. Those relationships drive gap closure reductions. When we're spending seven to nine hours per year of face-to-face time, those patients know and trust their care teams."

  1. Such partnerships result in more positive patient experiences. "UpStream partners with our primary care providers," Mr. Hemberg, a pharmacist and chief practice officer said. "We offer that support system to be an extension of the PCP so we can accomplish this work together. He shared an example of a realistic patient (not his real name). "George is a 72-year-old male with high social determinants of health needs," he said. "He's on more than 12 medications, which he's not adherent to. He's got numerous chronic conditions including uncontrolled diabetes, hypertension, morbid obesity and others. George is living at home by himself and is unable to coordinate all these levels of complexity by himself."

"UpStream gives him the extra help he needs to coordinate his care plan outside of the doctor's visit," Mr. Hemberg continued. "He's scheduled for a 90-minute visit with our clinical pharmacist within the walls of the primary care physician's office." During the specific pharmacotherapeutic workup, it's discovered that George is still taking a seizure medication that was only needed after a car accident and no longer has a supporting diagnosis. After consulting with his doctor, the clinical lead works to wean George off the medication, reducing risk of side effects and decreasing his overall pill burden.

"You're building trust with George through the conversation," Mr. Hemberg said. "It's not checkbox medicine. They also set up a weekly call with George from our concierge to check on his adherence to other medications, and his care team works to provide transportation to help him keep important appointments."

  1. A team-based approach moves providers closer to value-based care. Dr. Doddamani referenced an article from the Journal of Internal Medicine indicating that it would take an average of 27 hours for primary care physicians to accomplish all of the tasks that are associated with delivering preventive and value-based care. "In a team-based system, we can cut that down by one-third, which is much more manageable."

Dr. Reardon pointed out that UpStream's approach enables high diabetes medication adherence.  "Not only is the diabetes more controlled, but also we see downstream impacts," he said. "We might prevent a patient from having to go to the ER in the middle of the night with uncontrolled blood sugar, control some of the complications such as kidney disease and reduce medical bills, which are the number one reason for bankruptcy in the United States. All of that comes together to help achieve goals of greater value, richer quality, lower total cost of care and increased patient and provider satisfaction."

While healthcare is moving toward more value-based care, many primary care practices still struggle with effective implementation. By partnering with an organization such as UpStream, primary care practices can have experts who are supporting the practice, supporting patients, improving patient outcomes and lowering the total cost of care.

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