Is Primary Care the Solution to Value-Based Care Challenges?

September 21, 2016 - Transitioning to value-based care reimbursement and managing accountable care organizations (ACOs) comes fraught with specific challenges. Both reports from healthcare organizations and interviews with experts who’ve implemented ACOs tend to show that there are obstacles that need to be overcome in order to run an effective value-based care program. The sheer speed with how quickly providers are expected to transition to value-based care and accountable care organizations may pose problems, but gearing providers toward primary care may help, says Marci Nielsen, CEO at the Patient-Centered Primary Care Collaborative.

“There are a lot of challenges,” Nielsen explained. “The healthcare marketplace is changing so quickly and it needs that evolution. We’ve got to move away from volume-based payment to value-based payment. But on the one hand, we are at the forefront of really pushing that change and pushing policymakers to embrace that change. That’s our goal, but you’ve got to bring along the masses and the masses are those are primary care practices who are working so hard to take care of patients.”

“As the marketplace changes around them, it’s exhausting. The level of satisfaction that those practices have is dwindling and their burnout rate is growing because regulators, policymakers, and advocates keep asking them for more. The payments haven’t caught up with the requirements. The number one challenge is to keep those practices motivated, believing that payment is coming,” Nielsen emphasized. “On the other hand, we’ve got to be careful to not push them too fast. The way we pay for healthcare is incredibly complex. You can’t flip a switch and tell practices that tomorrow, it will all be new. The switch to value based purchasing can’t move too quickly.”

Taking the time to more deliberately pace providers in transitioning to value-based care while also emphasizing the importance of primary care among ACOs could bring greater success, maintained Nielsen.

Along with the fast pace of transitioning to value-based reimbursement, a report from the Center for Healthcare Quality and Payment Reform called Measuring and Assigning Accountability for Healthcare Spending outlines a number of other problems with value-based purchasing, according to the Michigan Health Policy Forum.

First, providers have sometimes been responsible for services that they have no control over while other services that could be better managed don’t have that accountability attached through value-based protocols. For example, the Centers for Medicare & Medicaid Services (CMS) has required some hospitals to reduce the readmission rates among patients who’ve been readmitted within 30 days. However, most physicians cannot be held accountable for whether a patient ends up with another condition or forgets to take their medications.

Another problem found is that some providers are penalized monetarily when they may be managing more complex cases while public and private payers also fail to provide the information necessary to reduce spending while keeping patients safe.

The Rural Monitor publication outlined interviews with providers participating in accountable care organizations in which the biggest challenges of this transition was covered.

Ann Morse Abdella, Executive Director of the Chautauqua Region Associated Medical Partners, mentioned how the lack of data exchange and aggregation processes was causing problems with care coordination and patient monitoring.

“Our major challenge in the beginning was the limitations of health information technology and data aggregation needs which were clashing with one another,” Abdella noted. “It’s very hard to get everyone on the same page. Some of the electronic medical records (EMRs) cannot or will not export data. This makes monitoring patients and coordinating care a challenge even still today. The data warehouses and analytics software in the early years were vaporware. It was just theory on how they would operate. ACOs were the guinea pigs for the new data software and care management infrastructure. Things are much better now, but it’s not perfect.”

However, implementing an accountable care organization has brought many more providers and payers to work together in improving patient outcomes and the quality of care, remarked Abdella.

“We have providers talking with each other, negotiating with each other, and problem solving with each other in ways we never had in the past. Forming an ACO really has been a catalyst to successfully working together. We still have a lot of work to do, but the tradeoff is that people are aware of that work, and they can pick up the phone and picture a real face that goes along with tasks. It’s been awesome. In the past, we may have seen little glimmers of this sort of collaboration, but it’s really snowballing and growing to scale. In our community, I think it’s reached a real tipping point towards real change,” she concluded.

Marci Nielsen also emphasized how accountable care organizations can meet the Triple Aim of Healthcare by bringing more focus toward primary care and following the best practices of other highly successful ACOs. Essentially, primary care may be one solution that could help overcome the obstacles associated with the complex transition to value-based care and accountable care organizations.

“We started about 10 years ago,” she mentioned. “We’re a nonprofit membership organization founded by the Academy of Family Physicians, the Academy of Pediatricians, and the American Osteopathic Association. At the time, we had a very expensive, fragmented and not particularly user-friendly health system. When you see those health systems that offer better value to their constituents, they often embrace the power of primary care. That was the goal of this organization: to elevate the role that primary care would play in health system reform.”

“We have clearly put primary care on the agenda for policymakers at the federal and the state level,” Nielsen concluded. “We have expanded who is sitting at the collaborative table. Beyond just physician organizations and employers, we have added many - if not most - other health professions that are critical to primary care such as nurse practitioners, physician assistants, psychologists, psychiatrists, and pharmacists who play an incredibly important role. All the folks from the industry perspective who contribute to health system reform and health information technology [have also been included.]”

Dig Deeper:

What Are the Benefits of Accountable Care Organizations?

How Payers Should Prepare for Value-Based Reimbursement