Collaborating for Value-Based Primary Care

Last month I moderated a webinar for the Network for Regional Healthcare Improvement (NRHI) High-Value Care Support and Alignment Network, which is part of the Centers for Medicare & Medicaid Services’ Transforming Clinical Practices Initiative (TCPI). TCPI supports more than 140,000 clinicians across the country in moving to value-based and patient-centered health care. The webinar, Navigating the Transition to Alternative Payment Models, featured three practices based in Portland, Oregon: The Portland Clinic, a multispecialty group with approximately 100 providers; Northwest Primary Care, with five practices and 26 providers; and South Tabor Family Physicians, a smaller practice with nine clinicians. These practices are part of the Portland Coordinated Care Association—a network of independent practices that collaborate and pool resources to lower costs, improve quality outcomes and enhance the patient experience.

These practices are leading the way when it comes to the transition away from fee-for-service to value-based payment, and they shared the factors that have propelled their evolution. Many were things you would expect—a commitment to medical home and population health management approaches like team-based care, care coordination and care management, and a dedication to using data to manage patients and design effective quality improvement initiatives. They focus on designing effective workflows and maximizing their use of technology.

But the practices also shared less tangible reasons for their success, which had much more to do with their organizational culture. And while I am deeply interested in the functions and processes of health care, these universal facets are equally engaging and, from the stories these practices shared, hugely important to practice transformation.

The first factor was leadership. Each of these medical practices made clear that their physician owners were wholly committed to delivering high-value care. They believed it was best for their business and their patients. Their commitment wasn’t part of an initiative or short-term project; it was woven into the fabric of their organization. It was not that they don’t participate in initiatives like HealthInsight’s Quality Improvement Organization projects or the Comprehensive Primary Care initiative and others— they certainly do— but they got involved because those programs aligned with their organization’s values, not the other way around.

Second, these practices talked about true collaboration, with one another and with payers and health plans. They talked about the power of sharing their data transparently—it motivated them and helped them identify best practices. When one medical practice achieved consistently high rates in performing foot exams for patients with diabetes, another practice struggling in that area asked what the other was doing and adopted a similar practice, increasing its rates consistently over time. This spirit of friendly competition and mutual assistance found its way into individual clinicians’ practices, and transparency became part of each practice’s culture. The practices also talked about working with payers, both to get the data they needed to succeed in risk-based contracts and to advocate for the financial models required to achieve consistently high quality.

The need to control health care costs is urgent, with broad agreement that the fee-for-service model of payment must change. Hearing from practices that have invested in this shift makes it clear that it is hard work done over many years and requires consistent and supportive leadership and a change in organizational culture. HealthInsight can help practices get started.