With growing pressure for independent practices to team up for accountable care and looming value-based reimbursement, many practices nationwide are uncertain of how to move ahead toward success for their practice and their patients.
At the Medical Group Management Association's (MGMA's) 2015 Annual Conference, this will be the focus of one session, co-presented by Stephen Cavalieri, chief medical officer for Richmond, Va.-based inHEALTH, a provider of population health management services, and Gerard Filicko, inHEALTH’s group's senior vice president of clinical services. inHEALTH provides services for MD Value Care, a multispecialty physician organization in Central Virginia composed of more than 450 physicians from 23 independent practices.
"At the end of the day, [value-based care] is coming,” Filicko recently told Physicians Practice. "This is the new environment that physicians have to be prepared for, regardless of what you think of the government or Obamacare …."
Filicko and Cavalieri recently provided a preview of their session and insight into their experiences at MD Value Care for Physicians Practice.
Physicians Practice: Why is population health so important to small medical practices? Why should it be?
Gerard Filicko: We have physician groups still operating under this idea that fee-for-service medicine is going to be around for a long time and I don't think that's the case. I think the way the industry is moving, the way the carriers are moving, the way federal and state governments are moving, we are seeing more and more value-based purchasing, more and more demand for demonstrating that the dollars that are spent in healthcare are being spent wisely.
We've worked here in Virginia with a group of 400 physicians for a number of years and have established some success, I think, in what an independent physician model could look like. We just wanted to be able to share some of those experiences with folks who are just now beginning to test the waters in value-based care.
Stephen Cavalieri, MD: Earlier this year, HHS announced the goals of tying 30 percent of Medicare payments to alternative payment models by the end of 2016 and 50 percent by the end of 2018. This is not going to be just for health systems. That's going to be for all physicians, tying quality measures to physician practices, hospital systems, skilled nursing facilities, home health agencies, [etc.]. The entire continuum of care is going to be increasingly measured by, and paid for, on how they can deliver in a value-based environment. The effect will be to de-silo American healthcare.
It isn't the patients you are seeing in your practice, it's the patients you are not seeing. Therefore, it's about the care transitions, the gaps in care, and the patient issues about which until now practices haven't known. So in a population health environment, systems need to be developed to track and close these gaps. One simple example is if you are diabetic and you haven't seen your physician in a year for your hemoglobin A1C levels or lipid panel, there is clear evidence that your risk of being hospitalized increases significantly. Until recently, physicians didn't have tools or workflows to figure that out. That's very important, not just for the physicians and their patients, but for the hospital system trying to prevent unnecessary emergency room visits, hospitalizations, readmissions, and untoward complications.