Dr. Christopher Crow, CEO, Catalyst Health Group.
Last year saw $41 billion invested in digital health companies. That’s billions and billions of dollars put toward innovating and improving a healthcare system that virtually all stakeholders believe is in desperate need of reimagination, reconstruction and revolution.
As a doctor who’s seen and fought the dysfunction of healthcare over the past 20 years, you’d think I’d be happier about that. Finally, the technologists and design thinkers and consumer experience evangelists will place concerted focus on creating a better model for healthcare, right?
Well, yes and no. What we’ve seen so far is that parts of healthcare are getting better for parts of populations. Tech-enabled concierge care is incredible for those who are fortunate enough to be members of those programs. Digitally enabled diagnostics and wearable biometric devices create the promise of more informed, proactive and preventive care . . . for those who can access the tools and work with providers who have the expertise and bandwidth to incorporate more data into their care planning and delivery.
So, while we’re at the precipice of a flood of innovation in care delivery, one crucial thing we’re still missing is a swell of voices demanding transformation in healthcare payment models. Is it as showy and shiny as a digital personal assistant who can tell you’re about to be sick by the sound of your voice? No, but consider the monumental impact in care experience, outcomes and cost we could create by investing more focus and resources toward changing primary care from its traditional, volume-based, fee-for-service (FFS) structure and moving it to a value-based prospective payment structure.
Impact #1: We’d stop hemorrhaging talented and compassionate primary care physicians.
First, we’d shore up stability among current primary care providers (PCPs). The Covid-19 pandemic demonstrated just how damaging a shake-up in demand can be to PCPs operating under FFS models that only compensate them when patients make—and keep—appointments.
In more rural areas, with lower-than-average demand for Covid-19 diagnosis/treatment and the decline of patient volume over multiple months, many practices simply didn’t have enough patients to make ends meet. In these cases, a prospective payment model with upfront per-member-per-month payments offers financial stability for a provider population that we cannot afford to lose.
A JAMA article published this spring reported that a quarter of clinicians surveyed in early 2022 said they “planned to leave primary care within three years.” Here in Texas, 228 of the state’s 254 counties are deemed to have a primary care shortage—nearly double the amount compared to 2019. The Department of Health and Human Services recently announced a $155 million award to drive growth in primary care as a specialty, but it will be years before we see the fruits of that work. We must take steps now to stem the tide of PCP migration, and that starts with movement to a payment model that can begin to relieve PCPs’ enormous financial, operational and administrative burdens.
Impact #2: We’d align incentives and resources toward improved outcomes.
The second big change we could see from a greater focus on and investment in primary care is innovation in how care is delivered, as well as what results we might expect.
PCPs increasingly turn to technology-enabled care teams who prioritize outcomes over appointments to extend the care provided, particularly to chronic-condition patients. These wrap-around services extend throughout patients’ care journeys and help ensure that patients receive the answers, support and peace of mind they need to manage their conditions far more effectively.
Programs throughout the country have shown the value of primary care investment and expanded access. In Rhode Island, a $27 million increase in primary care spending from 2008-2014 correlated with a $115 million reduction in the state’s overall medical spending during that time. In Oregon, for each dollar of additional money spent on patient-centered medical homes, “$13 was saved in other services, including subspecialty, inpatient and emergency care.”
By aligning outcomes to economics and then expanding how PCPs view and use care teams, we can remove burdens and fulfill the promise of what primary care was always intended to be, for patients and PCPs alike.