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Getting Your "Value-Based Care House” in Order by Embracing Primary Care

August 28, 2017
by Sylvia Dochterman, consultant, Freed Associates
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Regardless of what becomes of the Affordable Care Act (ACA), industry experts agree that value-based care (VBC) initiatives will likely remain, since VBC has considerable momentum and positive underlying drivers. It is impossible to get to VBC without a strong foundation of primary care accessible to consumers. Yet many primary care strategies have fallen short because health systems have focused on the old “heads in beds” mentality: build a primary care network so that you can generate referrals into specialists and hospitals. Instead, in today’s VBC world, we need primary care to keep patients out of the hospital.

Here are five key VBC-oriented questions to ask regarding your primary care offerings.

Improving Primary Care: 5 Key Questions

Question 1: Do you have a comprehensive strategy and action plan to sustain and grow your supply of primary care providers?

To build and sustain your primary care “network,” you need an adequate and easily accessible supply of providers to serve the unique needs and current and expected service demands of your patient population. If you have not implemented a plan to ensure an adequate supply of primary care providers, you will not survive the transition to value. Ask yourself:

  • Do we have a well-defined strategy to recruit new primary care providers to our organization?
  • Do we have a succession plan to replace primary care providers slated to retire or leave over the next several years?
  • Have we developed a plan to fully optimize the use of mid-level providers such as nurse practitioners (NPs) and physician assistants (PAs) in the primary care setting?
  • Do we have an adequate supply of trained geriatricians?
  • Are our primary care providers appropriately dispersed throughout our communities to provide geographic access to primary care to current and future populations?

Question 2: Has your organization deployed team-based care in the primary care setting?

When properly designed and deployed, team-based care has been shown to reap significant benefits in practices of all sizes and result in increased patient satisfaction and improved health outcomes. Consider the success of San Francisco-based One Medical in offering patients easily accessible, team-based primary care.

Common shared responsibilities in team-based care include pre-visit planning and expanded intake activities, including reconciling medications, updating the patient’s history and collaborating with the patient to set the visit agenda. Post-visit, services can include referral tracking and follow-up with community providers, health coaching, and even personal check-ins. Ask yourself:

  • Have you redesigned and redistributed work among all clinical and non-clinical members?
  • Are all team members working at the “top of their licenses”?
  • Are your team members the correct mix? Does the team include physicians, nurse practitioners, physician assistants, and nursing staff as well as non-clinical staff?
  • Are you investing in training of existing staff, redesigning workflows and instituting collaborative internal partnerships to keep personnel costs down?

Question 3: Has your organization implemented patient-centered access to team-based primary care services for both routine and urgent visits?

When patients can’t see their personal primary care provider and instead seek an alternative provider, we know that care quality and patient satisfaction suffers. We also know that costs increase when patients use the emergency department as an alternative to primary care. While urgent care has its place, it is not a substitute for a patient’s primary care provider—especially for those needing complex care management. If you are experiencing overutilization of your emergency department, look immediately to your primary care accessibility.

Being available to patients when they need and want is a key driver of value. If your patients can’t be seen same-day for urgent visits, or need to wait more than 10 days for a routine visit, you have access problems that will likely cause serious repercussions if not remedied.

If you don’t know whether you have access problems, perform an accessibility assessment now to understand whether patients can access their primary care providers when they want and need to do so. Improving accessibility to primary care will have a significant impact on cost, health outcomes and patient satisfaction. Ask yourself:

  • How long does a new patient have to wait to be seen by a primary care provider?
  • Do your primary care providers have policies and procedures in place to provide same-day access for those needing to be seen urgently?
  • Can patients see their primary care provider outside of normal business hours for both routine and urgent needs?
  • Do patients have the ability to schedule appointments online via a secure portal, whenever they want, as opposed to when someone is available to answer phone calls?
  • Are routine visits scheduled on evenings or Saturdays?
  • Can patients reach their primary care provider (or covering provider) by phone or secure email 24/7?
  • Do providers or their representatives taking calls have access to the patient’s medical record?
  • Do you track and report against access standards, and determine changes that need to be made?

Question 4: Has your organization implemented a population health strategy starting at the primary care practice level?

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