Wednesday, June 29, 2022 Jun 29, 2022
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D CEO Panel: How To Reform Primary Care

To change behavior, you have to change incentives.
By Paige Walters |

D CEO held its first virtual healthcare panel from the comforts of home to discuss primary care’s transition to value-based care and prospective payment models. Three panelists discussed how changing incentives would impact primary care providers, patients, and payors.

Our speakers included Dr. Christopher Crow, Co-Founder and CEO, StratiFi Health, Catalyst Health Network, Dr. Sanjay Doddamani, Chief Physician Executive and COO, Southwestern Health Resources, and CEO of MD Medical Group Alvaro Saenz.

Below are some highlights from the conversation, which were edited for length and clarity.

Crow on COVID-19’s impact on primary care providers in his network and company:

“While it is a terrible, terrible pandemic for all of us, the spring of creativity is overflowing right now. We went to the educational world of creating webinars and care magazines, and we’ve done 25 care alerts and 15 webinars. By March 20, we had 100 percent of the network doing telehealth, and it’s probably 50 percent to 85 percent of the visits, depending on the category of practice. We helped practices get PPE loans, connecting them to banks, helping them with their financials, keeping those practices up because it matches our purpose of helping communities thrive. We have over 500 new doctors that have asked to join Catalyst in the last month across Texas. It’s been an interesting time, for sure.”

Doddamani on prospective payment: 

“There is such a great need for a highly robust, very mature primary care infrastructure. It really is about creating that network and infrastructure for a high-quality primary care delivery, as well as specialty care and access to specialty care. If we were to continue on the current trajectory, without a change in our payment system, we would essentially go bust.”

Crow on how payment would change for access to primary care services:

“I compare it a little bit to what’s happened with cable TV. We had cable TV forever, and then, all of a sudden, there’s Netflix and Hulu and YouTube and all these other ways you can bundle the things that you want to consume. We have a variety of different styles and payments that are evolving. Some of them actually take primary care out of the premium insurance stack. On average, you spend 5 percent to 6 percent of the premium dollars on primary care. The more we spend on primary care, the better the results are.”

Saenz on general obstacles from payors, patients, and providers on transitioning to prospective payment:

 “There are infrastructure obstacles, for sure, and then there are just philosophical obstacles. The infrastructure obstacles are not to be underestimated because one thinks they are easy, and they are not. And, if you talk about any kind of value-based system, philosophically, that sounds really nice, but what you need behind that system is extreme coordination with the payor. Probably the biggest piece is the infrastructure part of it and being able to have the teams and the technology necessary to be able to digest the data.”

Saenz on caring for his patient group, what that looks like, what impacts compliance, and what he does for patients who do not head doctors’ orders: 

“Having that engagement with patients and meeting them where they are and giving them the flexibility to see you on the weekend or see you during extended hours or now, in telehealth, I think, makes a huge difference because otherwise, you are sort of rationing primary care to those who are able to get to your office in a 9-5 basis, and I mean, for me, my population does not fit that category. So what I need to do is adapt in a way to be able to serve their needs.”

Doddamani on what patients and healthcare providers can do to help move toward value-based care:

“Developing a large infrastructure to take care of patients outside of hospitals really then means you can open up capacity for the right patients that do need to be in the hospital. If you are clogging the hospital with hundreds of thousands of patients who really could have been cared for outside of the hospital, then you’re actually decreasing the ability for surgeries to be scheduled. I think it really is a patient-facing objective to really demand greater transparency and understanding the financial motivations.”

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