May 14, 2019

Physicians: Don’t Let the New CMS Primary Cares Initiative Happen TO You

Clinician Leadership | Leadership Development

Reading Time: 3 minutes

Recently, I participated in a panel discussion at the Midwest Independent Physician Association spring conference. Our discussion was on population health management and the current and future state of value-based delivery in healthcare.

It just so happened that the conference coincided closely with CMS’ announcement of the five new payment model options which are set to begin in 2020. This timing helped to create a rich and deep conversation with this group of independent physicians.

After years of hearing that transformation will occur in our healthcare system, many physicians, especially those who lived through the managed care transformation, have wondered if and when they will see the actual impact of new payment models that enable them to be involved in population health within their independent practices.

And while we now have a timeline for the CMS driven implementation that will impact primary care, with a testing period of five years, it still may seem like quite a while before independent practices start to realize benefit through the models. This thought was echoed during the recent panel where physicians felt disempowered in this change.

This is where I lay down my challenge to physician organization leaders. Stop waiting for someone else to empower you in this change. You have a real opportunity to prepare and lead through this transformation.

Don’t let it happen TO you. Help to LEAD it.

Here is how to start:

Maximize Efficiencies

Look at how you and your team treat patients. Are you fully utilizing your care partners? For example, determine if there is a better way to utilize Nurse Practitioners, Physician Assistants, Care Managers, and Health Coaches. Match the patient and the need to the care approach, and you’re already on a good path in preparation for the new payment models.

Think Differently About Care

You’ve probably heard it before: but providers need to consider wellcare an important element to healthcare. How can your practice move upstream in the care continuum? Think about ways to reach into the community and promote healthy choices and preventative approaches. Engage with existing community resources. Treating sickness before it starts will be critical to driving down the cost of care.

Build Relationships

Build relationships within your practice and with other physicians in your community. But, also look beyond your practice for professional networking. In fact, look beyond your discipline. Join local groups, like your Chamber of Commerce, Kiwanis club, church groups, and other networking events. Be bold and reach out to leaders of insurance companies in your locale.  Invite them to lunch just to get to know them.  Go without an agenda.  Just do it to get to know them.  You will likely be surprised about some questions that you get from them.  Building relationships within your community will enable you to brainstorm innovative options, build trust with key leaders in the community, and increase your influence once that trust is developed.

Proactively Develop Proposals

Rooted in the trust that you develop through this type of networking and leveraging your unique relationships, consider working with other physicians to develop proposals for consideration from insurance groups. At a minimum, if you’re networked, have increased your influence in the community, and are regarded with respect for the trust you have gained, you will create the space for dialogue to occur.

Value-based care is happening. It won’t go away, and it won’t skip over any geographic region in the US. It’s what is needed to ensure our healthcare delivery is focused on the patient and providing the best care for the optimum value. Follow these steps and you’ll be well prepared for the transformation.

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About the author

Brent E. Wallace, MD

Brent E. Wallace, M.D. is a seasoned physician leader, having been the Chief Medical Officer of Intermountain Healthcare for 12 years.

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