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Nine Steps to Accountable Patient Care


How can physicians move from traditional fee-for-service to value-based care? It takes nine steps, says one physician.

Accountable care organizations (ACOs) and other similar value-based payment models require physicians to improve care quality while reducing care costs. But that's no easy task.

To help physicians along the journey, Lumeris, an operations, technology, and consulting services company that helps organizations transition to value-based care models, recently released a "blueprint" describing nine steps to accountable care success.   

"It offers a framework for primary-care providers with work flows, metrics, and behavioral strategies," primary-care physician Tom Doerr, director of innovation research at Lumeris recently told Physicians Practice of the blueprint. "It enables them to successfully transform their practices from volume-based care to value-based care delivery."

Here's a closer look at Lumeris' nine steps, also known as the "Nine C's":C1: First contact. Physicians and practices need to ensure that the patient's initial entry point into the healthcare system is with a primary-care physician, said Doerr. One way physicians can do this? Provide open-access scheduling and more same-day appointments.

C2: Comprehensive care. Primary-care physicians should meet the bulk of patients' needs and only refer to specialists for uncommon problems, said Doerr. This requires physicians to practice at their highest level of training and provide longer patient visits (which hopefully will be a byproduct of reimbursement shifting away from volume of services provided to value (quality divided by cost) of services provided.   
C3: Continuous, longitudinal, person-centered care. Primary-care physicians must ensure that patients receive a regular source of care over time, regardless of the presence or absence of disease or injury, said Doerr. One way physicians can help initiate this? Provide personalized care plans that address prevention, screening goals, and advanced care planning.

C4: Care coordination. Physicians need to focus on coordinating patient care with other providers and other healthcare systems, including managing transitions of care between healthcare settings, said Doerr.  

C5: Credibility and trust. Physicians need to ensure that patients trust them as credible sources of health information, said Doerr. One way to build credibility and trust? Practice effective communication and goal-setting with patients.

C6: Collaborative learning. Physicians need to collaborate and share information with other providers and payers, said Doerr, adding that access to clinical data and claims data can help physicians meet this objective.

C7: Cost effective. C1 to C6 will help ensure physicians are reducing care costs, but physicians also need to ensure they are delivering the right care, in the right place, with the right provider, at the right time, said Doerr. Payers also need to step up and provide more transparency regarding claims so that physicians have more cost-related information at their fingertips.  

C8: Capacity expansion. To improve patient access to care, physicians need to ensure that each staff member is practicing to his highest level of license, said Doerr. If possible, practices should add nonphysician providers to their healthcare teams. Physicians also need to focus on providing more non face-to-face care to patients, such as E-visits, said Doerr, adding that reimbursement needs to change so that physicians are appropriately paid for these visits. 

C9: Career satisfaction. Physicians need to find more of a sense of "fulfillment and joy" in their profession, said Doerr. "To get to career satisfaction you have to pay primary-care physicians better, pay them sufficiently so that they can afford to get off the hamster wheel and be able to have longer visits with their patients," he said. "That makes for more meaningful relationships that are more satisfying and deeply rewarding."

What do you think of the Nine C's? What would you add or eliminate?

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