It’s Time for Congress to Make Integrated Care Central to the Nation’s Patient Experience | Commentary

Posted October 17, 2014 at 3:42pm

The primary objective of our health care system is to ensure that quality health care is readily accessible for patients. However, as health care becomes increasingly entangled in a web of networks, insurers, and providers, the patient’s best interest can get lost.

As a physician overseeing a network of dedicated health care professionals, I know firsthand that we can do better. But, the physician community can’t do this on our own. We need Congress and the administration to advance payment reform policies that strengthen integrated care models that are already showing great promise.

It is imperative that every member of the health care community — from doctors and patients to providers, insurers and policymakers — work to bring the patient back to the forefront. Not until our health care system — and its payment policies — put the patient first by incentivizing quality and improving the patient experience can our nation’s health care system fully flourish.

My vantage point in this complicated health care world has allowed me to witness what works best from the front lines of care. I believe we must reinvent individualized care delivery on a mass scale to ensure quality access for all. This all begins with practical and effective models that work for patients. And these models already exist today.

Health care reform centers around two key concepts. The first is an effective health care delivery model attaching physician incentives to wellness, prevention, and avoidance or delayed complications of illness, or high cost events. The model we at HealthCare Partners employ is successful and can be adapted nationwide. Under our system, primary care doctors and specialists are compensated with a salary and/or capitation plus a bonus based on quality metrics and patient satisfaction.

Next, we must respond to patient desires by expanding integrated care. A major frustration among patients is that their various care providers do not “talk” to one another. Integrated care is a system that allows doctors and sites of service to engage in steady communication, coordinating patient needs to improve care and efficiencies and reduce costs. This is especially important for those with multiple chronic conditions, since associated hospital admissions/readmission and complications costs are exorbitant. Integrating care could mean significant savings to health care.

Many providers such as our team at HealthCare Partners are now employing a coordinated, physician-centric approach, making doctors the clinical quarterbacks of multidisciplinary teams accountable for both quality and cost of care. The integrated delivery plan focuses on several key tenets, featuring a commitment to prevention, administration and coordination of care for multiple chronic conditions, reduction of hospital admissions and readmissions, and the delivery of compassionate end-of-life care.

When executed efficiently, the results of coordinated care are striking, including better patient outcomes and increased efficiencies, as well as reduced hospital admissions and readmission rates. These effects can be multiplied to a greater scale, saving our nation and taxpayers billions of dollars while allowing reinvestment into patient programs.

The first step for implementing coordinated care throughout our health care system, is to urge our elected officials in Congress to shore up Medicare Advantage, a model of coordinated care which is already working for patients with an astounding 90 percent satisfaction rate. This program, with nearly 16 million Americans, or 30 percent of all Medicare beneficiaries enrolled, is designed to offer seniors greater choice and is well positioned to deliver increased value to Medicare and high quality care to more seniors.

The MA model incentivizes (1) a team-based approach under which all health care providers practice at the top of his or her license; (2) care teams that organize to provide the right care at the right time in the most appropriate setting; and (3) physicians to address the patient’s total care needs. Savings from keeping patients healthy are reinvested into patient care.

Unfortunately, the positive results achieved by MA have not been fully appreciated by decision-makers in Washington. This program has been under extreme stress due to repeated funding cuts by Congress, thereby pushing seniors away from more efficient MA plans and onto the fragmented Medicare fee-for-service delivery model, which does not perform as well as MA in preventative care and hospital admissions. Over time, continued cuts to MA funding will reduce key benefits and access for seniors.

When Congress returns to Washington, I hope lawmakers will refrain from making further cuts to the MA program and instead achieve a financially stable Medicare program by strengthening the senior-preferred Medicare option that encourages greater care coordination and improves patient outcomes. MA is what seniors want and our health care system needs.

By doing this, patients will finally be placed right where they should be — at the center of care in our nation’s health care system.

Robert Margolis, M.D., is CEO emeritus of HealthCare Partners.