Focus on Better Health
March 1, 2018
Achieving the Quadruple Aim
By Joseph Frolkis MD, PhD, FACP, FAHA
President and Chief Executive Officer, New England Quality Care Alliance
For the next installment in my series on achieving the Quadruple Aim, I’ve chosen to focus on Aim number 2 – Better Health. We’re all aware of our current and challenging “two canoe” moment, as we transition from a volume-based, fee-for-service model to a value-based one, built on a foundation of effectively managing populations of patients, not just the individual patients we treat and care for. Having a foot in each of those canoes can get pretty uncomfortable, but there is an emerging consensus that the tide (unsustainable cost and poor quality) is moving us inexorably toward value – generally defined as quality/cost. We therefore need to understand and develop the tools we’ll need to be successful.
If we’re going to be compensated for managing a defined population (and potentially penalized if we fail to do so), we first need to make sure we know who our “population” is. This is why the need for effective registries has become so important. We’re responsible – and accountable – for patients whether they see us regularly or not. So, identifying our patients, and getting them into the office on some regular basis to assess their health status and preventive and screening needs, and diagnose conditions that jeopardize their health and drive up cost, are foundational needs for effective Population Health Management. This is the Primary Care sweet spot! It also supports our increasing focus on improving access across the NEQCA network.
Once we’ve identified those high-cost and medically complicated patients (the infamous “5 percent who cost us 50 percent”), we’re in a much better position to coordinate their care, provide the services and interventions that they actually need, and reduce unnecessary or wasteful (read expensive!) utilization. This will result in fewer ED visits, fewer Ambulatory Care Sensitive admissions, and fewer 30-day readmissions – all metrics on which we’re currently judged and compensated. This also means using specialists and hospitals that are willing to assist our network with these goals, and avoiding those providers who are not. While this can be difficult for PCPs who have long-standing relationships with community providers, it’s a critical piece of the puzzle. Fragmented and uncoordinated care leads to patient harm and increased cost – the “anti-value” proposition.
As care moves increasingly into the ambulatory space, and as baby boomers age into having multiple co-morbidities (the fastest growing segment of the Medicare population), our need to pay attention to the full continuum of care increases accordingly. That’s why we’re discussing post-acute care, palliative care, and the need to move these services whenever possible into the home setting. With the launch of the Wellforce Care Plan (our new Medicaid ACO), we’re also discussing the importance of addressing behavioral health needs and the social determinants of health – long-overlooked keys to effective population health management. These are all clear mandates from government payers, but as we all know, the commercial world is catching up.
It will not surprise you to hear me emphasize – as I often do – that NEQCA’s programs and services have been specifically designed to help our independent (and employed) physicians effectively and successfully respond to these challenges. It also underscores and explains our increasing emphasis on improving our efficiency – paying attention to both appropriate coding and to reducing cost and waste across the continuum of care – while we maintain our high quality.
This is a time of unprecedented change in healthcare. We need to anticipate, adapt and excel in order to continue our remarkable record of success.
Read about the origins of The Quadruple Aim.
Read my previous article on Higher Physician Satisfaction.