The final word: CMS physicians share experience at national leadership seminar

Monday, September 01, 2014 12:54 PM

by Michael J. Pramenko, MD, Executive Director, Primary Care Partners, Grand Junction, Colorado Medical Society Past President

Knowing is not enough; we must apply.
Willing is not enough; we must do.
-Johann Wolfgang Von Goethe

I was invited by the Center for Improving Health Care (CIVHC) to join CMS president-elect Tamaan Osbourne-Roberts, MD, at a leadership seminar at Stanford University in August.

The seminar was sponsored by the Network for Regional Healthcare Improvement, funded by the Robert Wood Johnson Foundation, and highlighted efforts in health delivery reform from several states. Featured speakers included CIVHC’s Jay Want, MD and Arnold Milstein, MD, who directs the Stanford Clinical Excellence Research Center and serves as the medical director for the Pacific Business Group on Health.

National trends
The program’s overall theme centered around the concept that inflation rates of public and private health care spending in the United States must effectively be addressed so that our society can properly fund other essential priorities like education and infrastructure. Indeed, health care spending has a chokehold on our economy, and on our competitive status in the world marketplace.

As we move farther into the journey on health system reform, more research is being done on delivery models that both lower per capita health care spending and improve clinical outcomes. We must improve on both variables as research indicates that focusing on quality does not always directly lead to lower cost.

With respect to cost, transparency stands to reshape the world of health care. The All Payer Claims Database here in Colorado is just beginning to influence how prices are set. And, of course, the days of fee-for-service reimbursement as the sole payment model for providers are certainly numbered. Right now public and private payers are testing value-based payment models that will de-emphasize its role.

For physicians, our biggest challenge will be to improve the quality of care we deliver. We must avoid the temptation to measure this by each individual we treat. On the contrary, the measure of our success will relate to our role in improving the health of a whole population. This is done one patient at a time, with the recognition that we are dealing with a scarce resource. Certainly treating each individual without any respect to cost ignores the health of the population.

Local implementation
Here at Primary Care Partners in Grand Junction, we are busy navigating the changes necessary to deliver on this value proposition while maintaining our autonomy as a private practice. As we are all experiencing, this change is stressful and the urge to maintain the status quo or sell the practice can be strong.

We are fortunate to have partners in this endeavor. Locally we have a robust health information exchange via Quality Health Network (QHN). Rocky Mountain Health Plans continues to lead the insurance company pack by stressing the Triple Aim here in Western Colorado, and is currently helping us with a new embedded IT tool to assess risk in our patient population. Hospital engagement with partnering on value-based projects shows promise. And some of our local employers are organizing to help leverage some of the needed changes here in Mesa County.

State pilots
From the state level, Colorado Medicaid is piloting a new payment model with RMHP and local providers. Under HB 1281, we are testing a new global payment for a segment of the Medicaid population. This new model will incentivize providers to focus on the sickest patients and emphasize the importance of physical and mental health.

From the federal level, the Affordable Care Act’s Center for Medicare and Medicaid Innovation has delivered on a payment model to support advanced patient-centered medical homes. Four practices here in Mesa County join over 70 in Colorado within this project. The Comprehensive Primary Care Initiative has funded care coordinators, behavioralists, a patient portal, an embedded pharmacist, and shared decision-making advances here at our large practice.

I agree with Dr. Milstein when he says, “physicians are the single most influential force in health care.” As we go about helping to guide health reform along the proper path, we simply must be willing to lead change. Our patients, our communities and our economy depend upon it.