On May 24, 2017, the Council of Accountable Physician Practices (CAPP) will host its third annual Better Together Health event, in partnership with the American Cancer Society (ACS) at The Center for Total Health in Washington, DC. Titled “All Systems Go! Closing the Gaps in Cancer Care,” the event will focus on how coverage and accountable healthcare systems can improve survival and reduce morbidity for people living with complex conditions like cancer.
Better Together Health 2017 will showcase stories of medical excellence and patient-centered care delivered by CAPP’s organized systems and medical groups, as well as an exciting policy keynote and panel discussion featuring these national physician leaders, policymakers and patient voices:
By Ira S. Nash, MD, FACC, FAHA, FACP, Senior Vice President, Northwell Health
As our country struggles to move our healthcare system toward the Triple Aim of lower costs, higher quality and a better patient experience, it is important to remember that physicians play an integral role in this transition.
Improving quality at every stage of the care continuum requires the collaboration and engagement of physicians. That is why a study published in January in the Annals of Internal Medicine needs to be more closely analyzed. In “Changes in Hospital–Physician Affiliations in U.S. Hospitals and Their Effect on Quality of Care,” the authors conclude that physician employment does not improve hospital care. While this conclusion may be technically correct, it does not have the broad policy implications that the authors suggest.
The definitions used in the study for physicians with an “employment affiliation” are so broad, they almost become meaningless. For instance, a hospital with a small number of employed physicians in a single clinical area such as radiology or emergency medicine was categorized as engaging in physician employment. This very low threshold on the definition of “employed physician” demonstrates a lack of understanding of HOW quality improvement is actually achieved.
It makes little sense to lump a hospital like that with one with a fully employed medical staff who are closely aligned with institutional initiatives around quality improvement.
From the Council of Accountable Physician Practices’ (CAPP’s) perspective, “employment” frames the issue in too narrow a fashion. It is the organization of physicians that is key to providing high-quality care. Specifically, our members have found that an integrated, physician-led care coordinated medical group does indeed equate to higher quality. Nothing in this paper speaks to what CAPP is putting forward as the model for what high-quality healthcare could be.
If the study authors had defined employment in a different way, or provided a measure of the extent of physician employment and organization, the results may well have been different. As CAPP continues to advocate for the longitudinal care of populations, organizing MDs into integrated physician-led medical groups will continue to be a point of advocacy for us. The issue of technical employment is secondary to how physicians are organized in clinical practice. Using such a broad brush to conclude that the employment of MDs isn’t driving the quality agenda is a disservice to us all.
Recommend Emphasis on Healthcare Delivery System Changes to Improve Care, Lower Overall Costs
As the “repeal or replace” debate over the structure of America’s healthcare system continues, the Council of Accountable Physician Practices (CAPP) urges decisionmakers to focus on healthcare delivery initiatives that are improving patient care, reducing medical errors and lowering the overall cost of healthcare.
“In the debate over healthcare reform, we must not ignore the importance of improving how healthcare services are organized and delivered,” noted Robert Pearl, M.D., Chairman of the Council of Accountable Physician Practices, a coalition of high-performing multi-specialty medical groups and health systems, as well as CEO of The Permanente Medical Group and president and CEO of the MidAtlantic Permanente Medical Group.
“If we do not continue to emphasize the need for care initiatives that promote physician-led, value-based, patient-centered, technologically-enabled care, we will lose ground in quality, innovation and outcomes that lower the cost of healthcare, while making it more available and convenient to patients. The consequences of inaction for our patients, their communities and the nation are significant.”
The foundation of healthcare delivery improvement rests on changes in payment incentives to providers, who instead of being paid fees for every service (the “fee-for-service” payment model), are now increasingly paid based on outcomes and performance. Innovations like electronic medical records and digital communications between healthcare teams, video visits with doctors, access to data to determine if patients are at risk, and improvements in preventive services are being adopted more rapidly to achieve better patient care and outcomes.
Pearl notes, “The CAPP medical groups are pioneers in linking physicians and patients with technology and digital communication, in delivering coordinated, connected care, and in forging patient/physician relationships that are both high touch and high tech. Physician leadership is behind all these improvements, ensuring that the welfare of the patient is first and foremost. When these enhancements are in place, patients get higher quality, faster care, medical errors are reduced, and better clinical decisions are made because information is available in real-time to all members of the team. “
CAPP physician leaders recommend:
Accelerated movement toward value-based payment for healthcare.
More widespread and coordinated use of health information technology so that care teams can access information related to patients’ health and treatment anywhere and anytime.
Simplification and standardization of quality measurement and reporting so that patients can identify healthcare providers with the best clinical outcomes.
These high performers can then help others to match their success and raise the national level of performance.
“Economics, not politics, is ultimately the most powerful driving force in healthcare today,” noted Pearl, who is chairman of the Council of Accountable Physician Practices (CAPP), a coalition of high-performing multi-specialty medical groups and health systems, as well as CEO of The Permanente Medical Group and president and CEO of the Mid-Atlantic Permanente Medical Group. “If we change the structure, modify how care is reimbursed, and embrace 21st century technology, we can improve quality and access, while at the same time lowering the cost of healthcare delivery overall.
“For example, through capitated payments, financial incentives will reward keeping people healthy, encourage prevention, maximize patient safety, and lead physicians to diagnose sooner and treat more effectively,” he said.
During his presentation, Dr. Pearl noted that attempts to change the healthcare cost equation in the past focused on reducing access to care, rationing medical care or reducing provider payment. None have proven effective, and all decrease quality and patient satisfaction. He supports the movement towards payment based on value, rather than volume, and recommends that the nation stay the course.
As part of the shift, he outlined various opportunities for clinical and operational improvements. Examples included approaches to reduce the time between surgeries and ways to minimize hospital care delays over weekend days. Dr. Pearl cited the success of the various CAPP medical groups in implementing digital communications and electronic connectivity as the types of innovations that have lowered operating costs across multiple sectors when implemented through large, physician-led multi-specialty medical groups. Similar innovative applications need to be widespread in health care in order to flatten the trajectory of health care inflation across the entire nation.
Dr. Pearl cited three specific technologies that are changing the way healthcare is delivered, including improving quality while reducing cost:
Video and digital photography that enable physicians to diagnose patients remotely and secure appropriate care immediately. One example of this technology in action is the use of video consultation with a neurologist to quickly evaluate a patient in the emergency department who might be having a stroke. This practice has already reduced the time for a patient to receive appropriate treatment by 50 percent.
Data analytics that can identify groups of patients and individuals who are at risk for specific conditions, or who require additional care.
Use of the electronic medical record not just as a repository of data, but as a communication tool between healthcare providers. This technology enables the best patient care decisions to be made at every point in the care continuum.
“When payment is tied to patient outcomes, and the re-engineering of healthcare delivery is led by physicians, we will see a reduction in the inefficient fragmentation that is so costly today, and improvement in the quality of care that patients receive,” concluded Dr. Pearl.
For information on patients’ experience of coordinated care and the use of technology with their doctors, see results from two Nielsen Strategic Health Perspective Surveys from 2015 and 2016, sponsored by CAPP.
Browse the pages of this site for more information on accountable care. To learn more about physician leadership in the work to achieve accountable care, and to receive updates on key health care issues, follow CAPP on Twitter at: @accountableDOCS.
The Council of Accountable Physician Practices partnered with CAPG — a trade association that promotes accountable care — to host a panel at the CAPG Colloquium held in Washington DC, on September 29, 2016.
The panel, “Physician Leadership in the Movement Toward Accountable Care,” featured four CAPP medical group leaders who discussed best practices for recruiting, training and developing physician leaders.
The panelists represented a diverse range of medical groups in size, geography and model. The panelists were Dr. Marc Klau, Southern California Permanente Medical Group; Dr. Philip Oravetz, Ochsner Health System; Dr. Lee Sacks, Advocate Physician Partners; and Dr. Nick Wolter, The Billings Clinic. Dr. Robert Pearl, Chairman of CAPP and CEO of The Permanente Medical Group and the Mid-Atlantic Permanente Medical Group, served as the panel moderator.
“It will not be possible to move the country toward accountable, value-based care without strong physician leadership at all levels of the organization,” said Dr. Pearl. “Healthcare systems should view physician leadership as a capital investment for the future with huge ROI. The CAPP medical groups are committed to sharing their considerable experience to help all provider organizations face the challenges ahead.”
Development starts at recruitment
Over the course of the discussion, the panel touched on key aspects of their physician leadership development approaches. All agreed that leadership development starts at the moment of recruitment into the organization. “Every physician is a leader. We start with that assumption,” said Dr. Klau. “Take every physician on as a leader and then expand their capability, because you never know when you will need them.“
Each of the medical groups has their own leadership training programs that have evolved over the years. Ochsner Health System, for example, has several tiers of leadership training that are designed to match physicians with their age and career experience. “We believe every physician is a leader by definition, but some exhibit their ability to lead more than others, or earlier in their career,” said Dr. Oravetz. “Our program exposes these folks to what a management career might look like.”
Regardless of the specifics of the training and development programs, the panelists overwhelmingly agreed that two critical traits for physician leaders are emotional intelligence and proven clinical excellence. “The best leaders are going to be visionary but anchored in reality,” said Dr. Klau.
“Self awareness is important to put on the table. What’s your humility? How do you develop people to create trust that’s necessary for good teamwork?” said Dr. Wolter.
Physician leadership as a strategy
Dr. Wolter stressed that physician leadership development should be considered outside of health care system payment as a strategy to improve care quality and patient outcomes. “No matter how the payment system evolves, if you leverage team care and leadership, that’s going to lead to better outcomes.”
Dr. Sacks agreed, saying that his group places leadership development at a premium. “It’s about improving care. The finances will follow,” he said. “Focus on what really resonates, which is improving outcomes.”
Following the discussion, the CAPG audience posed questions to the panel about the how-to’s of physician leadership development. The panelists agreed that physicians who aspire to lead their health system should start small. They mentioned that emerging physician leaders could join clinical improvement committees or attend the first stage of a leadership program as ways to determine if the track is right for them.
The panel was comprised of four of the 11 medical groups that contributed their case studies to CAPP’s five-part journal series about physician leadership development, which was published in the journal Healthcare: Delivery Science Innovation. The articles can be read in full here.
Photos courtesy of Thomas Van Veen of Documentary Associates
By Laura Fegraus, Executive Director, Council of Accountable Physician Practices
In the dynamic and often complicated movement towards “accountable care,” the need for dedicated and skilled physician leaders has never been greater. Physician executives at CAPP’s progressive multi-specialty medical groups recently pooled their collective insights, experience and advice on building physician leaders in a five-article series on this topic, published as a special edition in Healthcare: The Journal of Delivery Science and Innovation. The open-access articles are now available for sharing through this link.
Recognizing the shortage of “how to” guidance on physician-leadership development, this series addresses the specifics of building physician-leadership capacity within a medical group or health system. Through detailed case studies of their organizations’ efforts, the series’ authors present creative and proven ideas to recruit, train, and develop physician leaders within medical groups and health systems.
The introduction to this series, “Physician Leadership in Changing Times,” is a compelling call to action from physician leaders, Jack Cochran, M.D., formerly of The Permanente Federation; Gary S. Kaplan, M.D., Virginia Mason Medical Center; and Robert E. Nesse, M.D., Mayo Clinic Health System.
The authors discuss the history of the accountability movement from its inception with the 2001 release of the Institute of Medicine’s report on Crossing the Quality Chasm. Since then, there has been growing recognition that high-quality, high-value health care cannot be achieved through the uncoordinated actions of individual physicians and other healthcare providers serving the interests of individual patients, one at a time.* Instead, physicians must lead all stakeholders in the healthcare system to work together toward a broader vision of improved patient care experiences, better population health, and lower costs, otherwise known as the “Triple Aim.”**
The remaining four articles in the series detail the “how-to’s” of recruiting, retaining, and supporting robust physician leadership inside of our CAPP groups — including reflections on how to maintain organizational focus on this important cultural component during times of transition. Readers of this series will hear from organizations like Billings Clinic, Southern California Permanente Medical Group, Advocate, Henry Ford Health System, Ochsner Health, Intermountain, and HealthCare Partners that have successfully maintained and fostered their commitment to physician leadership, regardless of organizational setting or environmental context.
The multi-specialty medical groups that belong to the Council of Accountable Physician Practices are committed to nurturing the next generation of physician leaders, and are dedicated to sharing their best practices and learnings with other healthcare stakeholders. Effective and patient-centered delivery system change will be optimized by physicians leading and shaping the healthcare delivery organizations of the future.
To read the entire series introduction, please click here.
* Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001. ** Berwick D, Nolan T, Whittington J. The triple aim: care, health, and cost. Health Aff.2008;27(3):759–769.
With thousands of political offices up for election this November, health care will continue to be a complex and frequently debated issue. To help focus discussions, the Council of Accountable Physician Practices has produced an original primer, “What Every Candidate Should Know About Health Care.” This primer is for candidates running for local and national elected office and details the most critical health reform topics they must understand to ultimately improve the medical care their constituents receive.
The three primary issues highlighted in “What Every Candidate Should Know About Health Care” are:
Payment system reform to enable acceleration of the move towards value-based payment and away from the current volume-based fee-for-service model, aligning incentives to reward better patient outcomes, safety and efficiency.
Expanded use of health information technology so care providers always have the information they need to make the best care decisions.
Consistent and meaningful quality measurements to accurately identify high-performing medical groups and health systems.
By bringing these healthcare issues into the political discourse, the leaders of CAPP believe they can educate and inform elected politicians on the accountable approaches that produce the highest quality and best health outcomes for patients.
The American Journal of Managed Care recently published a second round of research sponsored by the Council of Accountable Physician Practices (CAPP) on the prevalence and magnitude of capitation and other alternative payment contracts among CAPP’s organized physician groups.
CAPP partnered with Brandeis researchers Robert Mechanic and Darren Zinner in 2011 to launch a longitudinal study. The focus of the research is to gauge the incidence of alternative payment contracts among CAPP groups, understand these groups’ previous experience with managing risk, and to define the approaches to physician compensation utilized by these groups. This published report is the second round of research conducted.
“This is one of the only published analyses examining payment and contracting practices for a variety of organizations across the full range of their payers. This allows us to better assess the relationship between contracting structures and organizational practices likely to positively impact performance” said Mechanic.
Twenty-two CAPP groups have participated in the survey’s second round, as well as 11 member groups of the Group Practice Improvement Network. The survey asked for information about quality and cost management programs, risk contracting, physician compensation changes and other factors to evaluate risk-based payment models.
According to survey findings, medical groups that received a high portion of revenue from risk contracts were able to more successfully implement advanced programs to avoid hospitalizations and provide care management. It also found that these groups placed greater emphasis on quality and patient experience in their physician compensation models and relatively less on the amount of care provided.
“Groups that had a higher proportion of risk contracts generally had physician compensation models with more emphasis on quality, patient experience and performance, compared to groups in fee-for-service models,” said Mechanic.
He predicted that future rounds of this survey would show a slow and steady movement toward alternative payment models. “Taking on risk is not easy or straightforward, so you really have to have an organization that believes in managing care and physicians that buy into the culture,” he said.
“The Brandeis findings are clear evidence that risk-based payment models allow physicians and medical groups to focus on the patient and their needs, not just on a bottom line,” said Laura Fegraus, Executive Director of CAPP. “CAPP is excited to be a part of this ongoing project to track payment reform progress and provide both current analysis and consistent historical accounting of the “pay-for-value movement.”
A third round of this survey is currently in the field. Results are expected in early 2017.
All agree that a more coordinated value-based healthcare system is required to achieve accountable care.
By Laura Fegraus, Executive Director, Council of Accountable Physician Practices
The leaders of the Council of Accountable Physician Practice (CAPP) have long been committed to accountable, physician-led, patient-centered care. It is our belief that neither the quality of American health care nor its cost can be improved without real systemic change. Such change must be completely focused on the needs of both physicians and patients to be sustainable.
Our Better Together Health events, coupled with our annual physician and consumer survey, are designed to highlight the concerns and experiences of both stakeholders as the American health system continues its journey toward accountable care.
Our most recent Better Together Health event was held on June 15 at the Kaiser Permanente Center for Total Health in Washington, DC. Once again, we announced the results of our annual CAPP-sponsored Nielsen Strategic Health Perspectives study. Designed to assess progress in achieving coordinated care, the study surveyed 30,007 U.S. consumers and 626 physicians to understand their experiences related to the hallmarks of accountable care: care team coordination, prevention, 24/7 access, evidence-based medicine, and use of robust information technology.
The survey results were both promising and concerning: The use of care teams and care coordination is improving. However, it appears that technology and 24/7 access to care is still not widely available. In addition, preventive primary care is critically lacking.
“This survey is evidence of the failure of American health care to provide coordinated, technologically enabled, high-quality care to the majority of people,” said Robert Pearl, MD, chairman and CEO of The Permanente Medical Group and the Mid-Atlantic Permanente Medical Group and chairman of CAPP. “While it is encouraging that the use of care teams and care coordination seem to be increasing, access and the effective use of technology still need improvement, and tactics that help to prevent illness are still woefully ineffective.”
Following the release of the survey results, policy makers, patient advocates, and medical group and health system leaders convened to discuss meaningful healthcare delivery reform at “Better Together Health 2016: Patient Expectations and the Accountability Gap.” The event was sponsored by CAPP and the Bipartisan Policy Center. The town-hall format of the meeting featured patient videos demonstrating the benefit of integrated care delivery at Southern California Permanente Medical Group and at Billings Clinic, both CAPP member groups.
Sen. John Hardy Isakson (R-GA), co-chair of the Senate Finance Committee’s Chronic Care Solutions working group, served as a featured speaker. Tim Gronniger, deputy chief of staff and director of delivery system reform at the Centers for Medicare and Medicaid Services (CMS) also spoke. Both shared strong support for moving our healthcare system toward a more coordinated, value-based healthcare system. The panel discussion was moderated by Ceci Connolly, CEO of the Alliance of Community Health Plans.
The first patient story featured Jenny, a Billings, MT high school teacher who underwent bariatric surgery after a lifelong battle with obesity. Dr. Karen Cabell, director of quality and patient safety at the Billings Clinic, explained how system-ness and integrated, patient-centered care supported Jenny to reach a positive outcome.
“To us, system-ness means having an integrated medical practice where it is the expectation that all of the physicians, nurses and other members of the team coordinate together and communicate with each other on behalf of the patient,” said Dr. Cabell. “The patient is part of that multi-disciplinary team.”
The event’s second story featured Jesus, a food services professional and father of three, who developed severe diabetes resulting from poor nutrition and lack of exercise. Dr. Marc Klau discussed how the Southern California Permanente Medical Group’s Diabetes Complete Care program helped Jesus overcome his chronic condition.
“It’s the best of all worlds,” said Dr. Klau. “You have a team, you activate the patient with resources and then behind it you have this high tech technology world that’s constantly monitoring to make sure Jesus gets everything he should be and if he doesn’t, the system activates.”
By bringing together the nation’s leading and most respected healthcare organizations, patient advocates, and policy experts, CAPP’s Better Together Health series seeks to amplify and accelerate the momentum on changing the health care delivery system so that it is patient-centered, integrated, and physician-led. We look forward to continuing this meaningful and relevant conversation at future events, and monitoring the nation’s progress towards true accountability through the two most important voices – the patient and the physician.
WASHINGTON, D.C. (June 15, 2016) – A new Council of Accountable Physician Practices (CAPP)-sponsored Nielsen Strategic Health Perspectives survey released today reveals that only half of patients are experiencing the benefits of coordinated care and only about one-third have 24/7 access to care outside of the emergency department. The report also finds sluggish progress in the use of health information technology to connect doctors and patients, and that patients, including those who are obese and at risk for chronic illness, do not report receiving prevention counseling from their physicians.
The 2016 Nielsen Strategic Health Perspectives surveyed 30,007 U.S. consumers and 626 physicians. It is the second annual survey that CAPP sponsored to monitor the progress of meaningful healthcare delivery reform and the movement toward accountability.
“This survey is evidence of the failure of American healthcare to provide coordinated, technologically enabled, high-quality healthcare to the majority of people,” said Robert Pearl, M.D., Chairman of CAPP, and CEO of The Permanente Medical Group and the Mid-Atlantic Permanente Medical Group. “We know that CAPP members, all committed to the multi-specialty medical group model, are best positioned to deliver superior outcomes to the patients they treat. CAPP stands ready to help others improve their care delivery systems, and to work with policymakers to facilitate these changes. These findings reinforce CAPP’s long-held belief that patient-centered care models are critical to closing the gaps between what patients need and what they are currently receiving.”
The survey measured respondents’ experiences with the five patient benefits associated with effective accountable care: care team coordination, prevention, 24/7 access, evidence-based medicine, and patient and physician access to and use of robust information technology.
Data from the survey shows that:
Eighty-nine percent of primary care physicians say they often remind patients about preventive screenings, but only 14 percent of patients say they get these reminders. More than two-thirds of adult Americans are overweight or obese, yet only 5 percent of patients report that their physicians recommended a weight-loss program.
Only half of patients are experiencing physicians who better know their history, primarily due to the ability to share information through electronic medical records. However, patients with multiple chronic illnesses, who would most benefit from care coordination, receive only slightly more follow-ups and care management as everyone else.
Patients’ electronic engagement with physicians is increasing but still low, with 20 to 30 percent of the total surveyed reporting that they have various forms of digital access like online submission of medical questions, email or text reminders. Roughly 44 percent report access to online information, such as appointment scheduling, obtaining lab test results, or viewing information via portals. Older Americans are less likely to want to use digital technology for healthcare, which presents a challenge in fully leveraging this technology to improve care delivery to this population.
Only about one-third have 24/7 access to care through their physician’s office other than the emergency room.
Sixty-five percent of physicians report using evidence-based guidelines to help determine treatment, with 39 percent of patients recalling discussions on new treatment options.
The leaders of CAPP, a coalition of leading integrated multi-specialty medical groups and health systems across the U.S. have long been committed to accountable, physician-led, patient-centered care. CAPP Executive Director Laura Fegraus said, “Our survey found that while it is encouraging that the use of care teams and care coordination seem to be increasing, access and the effective use of technology still need improvement, and tactics that help to prevent illness are still woefully ineffective.”
While these results show that delivery system reform is beginning to move in the right direction, the work is far from over. CAPP supports policy initiatives that can expedite performance in accountable care, including payment reform to support “system-ness” and better outcomes; more robust health information technologies to improve sharing of information among providers and easier access by consumers; and standardized quality measures in language consumers can understand.
For more information on the survey findings, click here.