Talcott Primary Care
Just within the city limits of Chicago, Talcott Primary Care, a five-provider practice, cares for a combination of Medicare and commercially insured patients, says Steven Pearlman, a family physician. He says the practice has always been ahead of the curve, whether it was adopting practice management software in the mid-1980s or an EHR system in 2006. Value-based care has been no different. They are part of an ACO through a local, affiliated health system, Presence Health, and have provided care management metrics through CPT Category II coding, "which facilitate data collection for the purpose of data management," according to the California Quality Collaborative.
While their efforts haven't been as financially rewarding as Pearlman and his team would have hoped, there is a reason the practice is maintaining efforts in value-based care. "We try to be aware of some of the changes coming down the road and then try to plan for it, so we're not in shock," says Pearlman. He also says the practice sees value-based contracts as a way to continue to develop long-term relationships with its patients, rather than the churn of fee-for-service care. "We're old school, we don't like to cram four patients in an hour."
The biggest challenge of value-based care is the added level of documentation required and the accompanying time commitment, says Pearlman, who complains that note bloat in EHRs is a very real problem.
Pearlman's advice for his fellow small-practice physicians is to seek help through strategic alliances. His practice has started to work with Fields' VillageMD to understand best practices and how to successfully implement a value-based care model that can be financially viable. He says without help, small practices' hopes of succeeding in a MACRA environment will face steep odds. "Quit being a lone ranger. It's not going to get you very far. Even the Lone Ranger had Tonto," he says. "There is no silver bullet, but learn from each other."