Healthcare providers want to break free of the broken throughput model of healthcare delivery they inherited and instead embrace a more relationship-based, patient-centered model of care.
Putting aside the throughput model allows providers to spend time addressing patients' underlying needs, while offering primary care physicians greater autonomy and accountability for their patients.
During an August webinar hosted by Becker's Hospital Review and sponsored by MDVIP, experts on the future of primary care detailed the transformational nature of this approach:
- Marty Makary, MD, professor of surgery, Johns Hopkins School of Medicine
- John Schmidt, executive director, health systems, MDVIP
Four key insights:
1. Typical quality metrics fail to consider the appropriateness of care, placing primary care at the forefront in filling the gap. Today's healthcare practitioners inherited a broken system, in which quality metrics assess the consequences of a medical intervention, rather than whether the intervention was even necessary. The new "science of appropriateness" relies on the "clinical wisdom of great primary care providers," Dr. Makary said.
"A new generation of primary care has emerged," Dr. Makary explained, "to take ownership of this population. [They] want to be accountable for their downstream outcomes and cost." They use data to take an active role in coordinating patient care. These providers form teams, look to patients' underlying issues and seek to de-prescribe medications where appropriate.
2. Transforming fee-for-service to a relationship-based practice of medicine improves care and meets the needs of patients and providers. Addressing appropriateness "is the effort now to convert primary care from a fee-for-service model into a relationship," Dr. Makary said. Patients and providers are looking for a different model: subscription-based, value-based primary care that drives quality.
Relationship-based medical practice requires an investment of time but mitigates physician burnout due to the loss of autonomy. In fact, the primary care doctors who love their jobs are the most engaged.
This evolution faces market hurdles as over 70 percent of physicians are currently employed by health systems. Some "health systems are looking to provide solutions to patients that want something different and are willing to invest in it," Mr. Schmidt said. The business strength of the value-based model was demonstrated by the ability to adapt quickly when COVID struck without waiting for CMS bureaucracy to approve changes to modes of care.
3. This transformation goes beyond preventive medicine to a complete redesign of care. Preventive care doesn't capture how thoroughly different the value-based model of care is. Redesigning healthcare to allow for an autonomous, capitated, time-intensive approach enables primary care to own the patient journey from beginning to end. The physician feels more accountable to see the best outcomes for patients. The health of physicians practicing in this way improves, too. "There's time to focus on the patients, but then also focus on your life and well-being," Mr. Schmidt said.
4. Healthcare consumers will drive change. Patients increasingly act as consumers, determining how to spend their money. "To see a paradigm shift, the health systems have to recognize that healthcare consumers are now in control of their dollars," Mr. Schmidt said. Consumer demand for something different will prompt change in the market.
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