Alan Weil on Payment Reform

“We should remember, however, that payment reform is a tool, not an end in itself; and we should be clear about our goals and then deploy the tool where it can help us achieve those goals”

Alan Weil, Editor-in-Chief of Health Affairs, has written a two part blog series on payment reform over on the Health Affairs Blog.

Part One, “Why I Oppose Payment Reform” and Part Two, “How to Succeed at Payment Reform (By Really Trying)” are available now.



Two full hours with your doctor, with just one small twist…

As part of the APM Pilot, clinics have been taking part in learning collaboratives focused on Advanced Care Models (ACM). This blog is going to profile some of the ACM topics being discussed by the group and how the clinics are going about implementing new approaches.

The demand for primary care doctors has never been greater. One study calculated that the US health care system would need around 52,000 new primary care physicians by 2025. And health care systems are already feeling the strain of the estimated 9.3 million patients newly insured under the Affordable Care Act.

How are health clinics going to meet this need? They are getting creative—and that includes new ways patients can see the doctor.

Group visits

One model of care that is gaining popularity is group visits. Think of an extended doctor’s office visit that hits many points and gives patients lots of time to ask questions. The catch? You share the visit with a group of other patients, all with the same diagnosis or health condition.

Group visits let physicians provide in-depth education to their patients; they also include medical evaluation and treatment. While it may seem odd to think about sharing a doctor’s visit with a bunch of strangers, it lets patients have much more time with the physician than they could possibly have in a one-on-one visit. Continue reading Two full hours with your doctor, with just one small twist…

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How Do Alternative Payment Models Fit In With State And National Reform Efforts?

By K. John McConnell, PhD

(Note: This article originally appeared in Health Affairs Blog on December 1, 2014. An edited version is being reposted here as part of the research effort investigating the impact of Alternative Payment Methodology (APM) on the delivery of primary care in safety-net populations. Through this website, Frontiers of Health Care, we are sharing lessons learned and perspectives from key stakeholders on the frontlines of reform.)

The Affordable Care Act has affected health care at almost every level. Extensive experimentation within states continues to create changes. Given all these shifts, it is helpful to step back and consider how alternative payment models (APMs) fit in with these reforms, and why they are critically important.

Many describe the Affordable Care Act as a means to expand coverage, with relatively little emphasis on controlling costs. This is an oversimplification — accountable care organizations are designed to address costs. New “productivity adjustments” in the Medicare program are also intended to check spending growth. But these changes, while real, represent a patchwork approach to controlling costs that probably do not address the underlying problem.

The lack of a wholesale approach to cost control would not be problematic if the long-term spending outlook were not so grim. As documented extensively by the Congressional Budget Office, the federal debt will grow to unsustainable levels if health care spending is not slowed substantially. So, how do you address the growth in spending? Continue reading How Do Alternative Payment Models Fit In With State And National Reform Efforts?


A New Paradigm: Health Coaching to Manage Long-Term Health

As part of the Alternative Payment Model (APM) Pilot, clinics have been taking part in a learning collaborative focused on Advanced Care Models (ACM). This blog is going to profile some of the ACM topics being discussed by the group and how the clinics are going about implementing new approaches.

What if the person giving you medical advice was more like your friend or a trusted mentor and you weren’t limited to 5 minutes? That’s the idea behind an approach called “health coaching” that is spreading in the world of primary care to help patients understand their chronic conditions and learn self-care.

Health care has four principles that are considered the “golden rule” of ethical care: beneficence, non-maleficence (i.e., do no harm), respect for patient autonomy, and justice. Many have said that our current system of care does not allow doctors and other health care providers to actually achieve these four principles—and that’s one of the reasons some systems are establishing health coaching for their patients.

Too often, it is low-income or ethnic minority patients who have the most barriers to understanding clinical information provided by a physician. Coaching shifts the care model—instead of a brief visit with a clinician being the source of all information, the critical health information comes from a support person, who is given more time, is trained in communicating well, and can make a personal connection with the patient. Continue reading A New Paradigm: Health Coaching to Manage Long-Term Health

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Counting on Analytically-Minded Physicians

By Glenn Kautz, MPH

It’s been estimated that upwards of nine million Americans now have health insurance as a result of the Affordable Care Act (check out this impressive visualization). While it is clear that more primary care physicians are needed to meet the demands of this newly covered population, of equal importance is the type of primary care physician that is needed. Primary care physicians of the future will need diverse skillsets in areas such as behavioral health and community organization, along with strong analytic skills to effectively care for their patient populations.

Alternative Payment Models (APMs) highlight the need for such a primary care physician, as individual clinics and groups find innovative ways to deliver quality care more efficiently. Approaches utilizing Population Health Management, Health Information Technology and Quality Improvement necessitate physicians trained in disciplines such as statistics, finance and informatics.1,2 With training in analytic fields, physicians are able to collaborate with experts and generate solutions to complex problems incorporating patient-, clinical- and population-level elements through an analytic lens. Armed with such skills, physicians will also possess the knowledge needed to advocate for more effective payment models that facilitate the best care for their communities.

Continue reading Counting on Analytically-Minded Physicians