Pri-Med Southwest: Primary Care is the Key to Improving the Value, Quality of Health Care

Keynote at second day of Pri-Med says that primary care is at the heart of the push to provide high-quality, lower-cost medical care.

The United States leads the world in health care expenditures. Yet, in 2007, the US was ranked only 37th in overall health care quality by the World Health Organization.

At the 2011 Southwest Pri-Med conference, Paul Klotman, MD, President and CEO of Baylor College of Medicine, discussed accountable care organizations (ACOs) as a vehicle for health care reform. During the talk, “Improving Value in Health Care: A Partnership between an Academic Medical Center and Primary Care Physicians,” he explored the roles that primary care providers (PCP) and academic medical centers (AMC) might play in that process. The overarching message of the lecture was that the value of health care must be improved. What does that actually mean? It means giving patients the best medical care at the lowest cost.

ACOs can be the vehicles for improving value

An accountable care organization is a group of health care professionals and hospitals that accept shared accountability for the total cost and quality of care delivered to a defined set of patients. In order for this to work, financial incentives must be aligned across all participants in an ACO. The current fee-for-service system does not demand accountability for quality and efficiency.

PCP will be cornerstone of ACO

Physician-led ACOs will allow physicians, not hospitals and payors, to make the best decisions for the nation’s health. According to Klotman, physicians should lead reform because they have been called to save patients and they are the best patient advocates in the health care system. This approach would require physicians to abandon the traditional physician-centric model and establish a culture of teamwork among practice staff—with the PCP serving as a team leader, not a gate keeper. The gate keeper model was all about cost containment, not outcome. Instead, ACOs focus on value.

Patient-centered medical home (PCMH)

The PCMH is intended to improve patient access to health care focused on quality and patient satisfaction through coordination and integration of care. Via the PCMH, each patient has a personal physician who directs a team-based medical practice that is oriented toward the whole person. In other words, it is about health management, not disease management.

Value will require integrating health care across all providers

In 2001, only 17% of PCP in the US was using electronic medical records (EMR) compared with nearly 90% in the United Kingdom. Coordinated and integrated health care requires that a cross-platform interoperative EMR is used by all physicians. Ideally, health care information would be shared between inpatient and outpatient settings to improve handoffs and to avoid duplication of services.

AMC & PCP can partner through ACO

PCP can provide AMC with valuable input, a referral stream for specialists, and more sites for educational encounters and clinical research trials. AMC will need to integrate their services with local primary care practices or develop primary care networks. They will also need to be prepared to better contain cost. AMC are ideally positioned to create partnerships and support data exchange through EMR support and other means.

Potential advantages for PCP include: selling tangible assets of their practice, becoming employees of academic medical center, improving practice, giving up headaches of day-to-day practice, continuing to control the destiny of healthcare, serving as academic faculty, and participating in primary-care-based research networks.

Ultimately, in order for this to work, all partners would have to agree to a primary goal of value creation and be willing to explore a variety of flexible business models.

More detailed information about accountable care organizations can be found on the Center for Health Care Quality and Payment Reform website.