We spoke with Paul Grundy, MD, MPH, FACOEM, FACPM, about the fundamental change that is occurring in how physicians and patients interact. Known as the Godfather of the PCMH, Dr. Grundy is the founding President of the Patient Centered Primary Care Collaborative (PCPCC) and is IBM’s Director of Global Healthcare Transformation.
Here are the 4 must-know insights for physicians, no matter where they are in their career.
1. The future of health relies on using the health data at our fingertips.
“For the first time in history we are going to get [and better use] data in health care,” explains Dr. Grundy. That may conjure up images of a comprehensive platform such as EngageHealthIQ, or tools like Watson, EMR or simply a patient registry. Either way, it is critical to recognize that health care has fundamentally changed, says Dr. Grundy.
New information is created not just from behaviors, but biometrics and beyond; this data should then be better aligned with behavioral support systems and the right incentives (and feedback) for robust and coordinated care.
“I fundamentally think one of the driving forces for transformation is that we are going to have data,” says Dr. Grundy. As one of the last industries to make this shift, it’s time that doctors, too, become accountable to managing a population using the facts and data available to them.
2. We’re now attaching data to a healing relationship, for better, more effective care.
For practices looking to get a more accurate, ongoing picture of their patients’ health, not utilizing the data that we can collect, means we aren’t being as effective as we could be—from both a communication, and an overall care, standpoint.
“The thing about data is that when you have data, in any industry, there is an expectation that someone is going to be accountable for that data, and that data will be acted on,” continues Dr. Grundy. It’s up to physicians their teams to better manage that data, starting now.
It’s time we see we are accountable to that data for better population health management.
“If you think of this in terms of where we are as an industry, we are fundamentally master trainers. We are trained in a way that goes back to the turn of the last century. We are trained to basically [house] that information that exists about treating patients, and use our heads as our biggest repository,” Dr. Grundy says. While that’s the model the master builder followed in the middle ages, that’s certainly changed thanks to technology and even patient expectations, Dr. Grundy says.
3. Communication will either improve, or take away from, our ability to deliver care.
In the past, we saw system-wide innovation come in the form of the automobile. The automobile, Dr. Grundy points out, enabled physicians and their teams to reach patients (and for patients to reach care facilities) quicker, and on a much wider basis.
And now technology is enabling this provider “reach” to patients to extend even further, across the entire care continuum, and even into patients’ homes. “There are [many forms] of communication that can occur asynchronously, and remotely with mobile. That [ability] is going to transform how we communicate in health care.”
Engagement won’t just mean face-to-face, in-person encounters in the future.
4. An evolved payment model rewards not just clinicians, but patients as well.
The nature of communication is changing, and a central part of that doctor-patient interaction is the underlying insurance and benefits system a patient is a part of. By and large, the majority of physicians are still in a fee-for-service model, and the majority of encounters are face-to-face, explains Dr. Grundy. “We are beginning to see that shift.”
What’s helping drive the shift towards a more innovative model is an understanding in most people’s minds, and most medical economists’ minds, that when you pay for an episode of care in a purely fee-for-service world, the system will tend to deliver services. “When you pay for fee-for-service only, you get too much service—over-service,” he adds. Currently as much as 17 percent of physician team payments do not come from the pure fee-for-service model, a number that is set to increase in the coming years.
Why do we expect that percentage to continue to increase?
“There’s a clear understanding from both the providers and payers that pure fee-for-service has failed us,” says Dr. Grundy. Physicians moving away from the model are saying, “If I engage my patients more effectively, if I engage him and the results are better, then I am going to earn more money.”
Smarter Use of Information Can Benefit All
Through this evolved form of engagement, we are beginning to understand the science of patient engagement and that relationship between physician and patient. When the system rewards outcomes, and more accountable care, everyone in the health care system can benefit. As we move towards this more effective model of care, how can we summarize the changes that need to take place for quality-driven choices, and better health outcomes for all?
Fundamentally, there is practice transformation. Beyond this, practices being paid to transform to a patient-centered approach, and an insurance/benefits design that encourages an individual’s self-management and engagement with her health.