The current crisis stresses our need for value-based physician care.
Opinions expressed by Entrepreneur contributors are their own.
Americans are worried, and the financial markets are terrified. The number of detected individuals with coronavirus (COVID-19) is ticking upward, schools are closing, lawmakers are considering price-gouging legislation and waiving fees to encourage the poor and uninsured to get tested, and more and more people have converted from, “This coronavirus thing is overblown” to, “This is a grave concern.”
Coronavirus is, indeed, a very significant concern. The speed with which it spreads is alarming, especially when you consider how an underlying, often overlooked element of society is accelerating it. The element I’m alluding to is the status quo, employer-provided health benefits that insure nearly 160 million Americans. These “benefits,” usually unbeknownst to business leaders, are pointing a large proportion of American people to unsatisfactory care centers built on a fee-for-service system that fails them and their physicians.
It fails patients in numerous ways: long stretches of time between when an appointment is made and when it actually happens; too much time wasted in waiting rooms where the virus can be easily shared; and too little time spent with their physician, to name a few. All these are particularly true in primary care, where it can currently take anywhere from six-to-24 days (in some locales, it’s over a month) before a patient can be seen.
This is problematic under normal public-health conditions. It’s potentially catastrophic in the face of an outbreak, where people who feel they may need medical advice delay or forgo it since seeing a primary care doctor is so difficult, and where those who do decide to preventatively visit spend ample time in germ-laden waiting rooms. They may not come in with coronavirus, but they may very well leave with it.
So, what is the solution? And what on earth do health benefits have to do with all this? The answer is reimagining primary care to support value-based physicians and employers redesigning their health-benefits plans to connect beneficiaries to these empowered medical professionals. Value-based physicians and the practices they work for are beholden to a
different standard of care. They are reimbursed according to how well they do their job (i.e. keeping or making people healthy) and are therefore given the freedom to do whatever it takes to make that happen. In a potential public-health crisis, that would more than likely mean utilizing 21st century capabilities to connect with patients while they’re still at home, reserving in-person appointments only for those that absolutely need it.
When you remove the distortion of requiring people to come in for what can be done electronically, we can have a more effective and timely response at a time when it matters most. We can also avoid overwhelming testing facilities. The problem of poorly performing fee-for-service primary care extends well beyond the coronavirus, but it highlights the need at a time when people are focused on one manifestation of the problem.
STAT News has reported on this trend of using next-generation primary care during the coronavirus outbreak. “We think we can really help direct people to the right care at the right time and give them quality information as it relates to this problem,” Dr. Brad Younggren, chief medical officer at 98point6, told the site. He added: “We can keep them from going into an environment to be tested when maybe testing isn’t necessary.”
Some are already doing this. They’re creating informative online guides and fielding phonecalls to answer patient questions and assess symptoms, and all the while, they’re keeping the patient’s unique medical needs and life circumstances in mind. Do they have comorbidities? Do they have access to transportation if it’s needed? Do they have young children or elderly adults at home, and to whom they could pass along the virus?
That latter part is why urgent care centers and telehealth can only go so far. Without being connected to a strong, value-based primary care foundation, they have a tendency to treat point-in-time problems rather than locate those within the patient’s broader health landscape. This can cause potentially life-threatening things to be overlooked or induced. (The opioid crisis is a perfect example of patients receiving addictive prescriptions for something — lower back
pain, most often — that could have been better addressed by taking into account the person’s lifestyle, suggesting modifications and walking them through drug-free treatment options.)
There’s a role for business leaders to play here. Every CEO states that employees are their most valuable asset, but unfortunately, old-line health plans designed to optimize Wall Street quarterly earnings appear to take precedence. Modern health-plan design avoids the many harms that come from unnecessary exposure to pathogens or unnecessary prescriptions to highly addictive drugs such as opioids and benzos. Both are getting over-prescribed at rates
unlike anywhere else in the world in our flawed, volume-centric, fee-for-service primary care clinics.
To really treat employees like they are their most value asset, employers should not hesitate to talk to their benefits advisor about how they can connect their employees to this type of superior care. They should cut ties with their old-line insurance carrier and not only go self-funded, but break free from old-line approaches. This enables them to regain the power to select the trusted partners to help steward their employees’s lives.
This revolution has already started. What’s happening right now with coronavirus is exactly why we must ramp up those efforts.