As we’ve highlighted in prior posts , the Alternative Payment Methodology (APM) has freed up health systems to dive into alternative ways of providing care. Many of these health systems were already experimenting with new approaches, and APM was designed to bring payment more in line with this kind of care innovation. For many health systems, part of this shift in practice management involves more team-based care including increased responsibilities for Medical Assistants (MAs). In fact, the Bureau of Labor Statistics estimates the employment of Medical Assistants will grow 29% from 2012 to 2022.
MAs are finding themselves with more to do, specifically related to panel management and health maintenance activities for patients. An MA has always had a broad role in medical practices. They perform a wide variety of tasks such as: reception, medical chart filing, escorting patients to rooms, getting medical history and vital signs, basic lab tests, patient instructions, and telephone calls to patients. Under the new model in many practices, the MAs are now “scrubbing” or reviewing a patient’s medical chart when they come in for an appointment to make sure the clinical staff cover preventive health needs.
We talked to an MA at one of the clinics implementing the APM pilot to get a closer view of the day-to-day changes. She says MAs are checking a lot more, such as reviewing patients charts before their visits to look for flu vaccination, whether their tetanus shot is current, or diabetes indictors. And all of these checks happen before the doctor even sees the patient. While the primary care provider also checks for these things, having an MA review the chart before a patient gets into a room can make the visit run more efficiently. The MA can start some tests ahead of time or just put something on the radar for the provider to discuss, such as whether they are due for a mammogram or Pap test.
Changing roles for the MAs also means that the MA supervisor role has shifted. Supervisors are circulating around the clinic to make sure the MAs are adjusting to the new workflows related to prevention and health maintenance metrics. Leadership at all levels is crucial to successfully changing the model of care.
Clinical staff are not the only ones being asked to change. Patients too must get used to a different mindset focused on prevention. The MA we talked to said the shift to being proactive is sometimes surprising to patients. It often falls to the MA to explain why a doctor wants to see the patient again, for example, if health measures such as blood pressure or diabetes numbers are not in range.
It is important for everyone involved including the front and back office staff to understand how the payment methodology works and its intertwined relationship with having a whole care team working actively with patients. For example, phone call reminders to patients are not going to be effective if the people in the back office cannot make the patient understand why it’s important for them to commit to preventive care rather than just calling and saying the doctor wants to see you. That requires both some health knowledge and a willingness to reach out to people.
Staff and providers are still coming to understand that this change is about more than just a different mechanism for being paid. Being a primary care medical home is a much bigger mission and vision for clinics—and the APM is just one way of helping them get there.
Alan Weil, who directed the National Academy for State Health Policy (NASHP) for a decade before he became Editor-in-Chief of Health Affairs, says “To truly effect change in the system, we need to focus on the process of delivery system improvement as much as we focus on the financial model. Financial incentives are powerful, but for organizations to change, they must see a viable path to transition from where they are to where we want them to be.” Indeed, team-based care is central to the APM model. The payment piece goes hand-in-hand with having a whole team working for the better of the patient.
The APM is just one approach to try to change the payment metric from quantity of care (i.e., number of doctor’s visits) to quality of care and patient health outcomes. If a health center gets paid per patient instead of per visit, then they can shift resources to calling patients to remind them to take their medication or offering more preventive health services ranging from health classes to cancer screening. The clinic is no longer focused on increasing the number of doctor-only visits, but has the flexibility to expand team contributions so that nurses, MAs, behavioral specialists, and other office staff are working to the highest extent of their training.
Initial indicators about APM’s effects are positive—in terms of extremely preliminary metrics and how the clinics are feeling about the changes. But it is still very early in the process, and the metrics, in particular, are still being refined. The real knowledge of whether this payment structure will lead to the kinds of outcomes the participants are hoping for is still a year or two away. Meanwhile, clinic staff, management, and even patients are adjusting to a new paradigm of proactive preventive care, and the role of the MA is expanding and becoming an important piece of clinic teamwork.