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It Can Be a Beautiful Day in the (Primary Care) Neighborhood

by Timothy Dudley, MD

Why am I as upbeat and optimistic as Mr. Rogers? Because getting paid to do all those things we said we could do for our patients, if only we had the resources, seems just around the corner! This is not your father’s Pay-for-Performance structure: this is real money for “care management” on a per-member-per-month basis.

How’s that for a neighborhood we all want to call home?

If you’re in primary care—and we all know we need a lot more of us—you’re probably hearing a lot about care management. This is a model where you are responsible for proactively engaging patients and managing all their contacts within the health care system. You’re probably also hearing about “volume to value.”  Here, you won’t be paid as much for doing everything you do, only for those things you do well!   

To be successful in these endeavors, we will need a friendly neighborhood with good neighbors. This has always been true to a degree if you think of the medical neighborhood as the health care version of “it takes a village.” But this used to be an easier place to live. 

When I admitted and rounded on my own patients, I knew all the specialists I asked to see my patients. I knew them as colleagues and I drank coffee with them in the hospital cafeteria. I saw them at grand rounds and served with them on committees. Since I don’t go to the hospital anymore, all those relationships are now hard to find.

And I admit to being a bit skeptical because care management sounds like managed care and that was an experiment I did not enjoy. Capitation wasn’t much better. But, I would like my patients to be well cared for and I hope that this time around the experiment will succeed.

I dream of a care management system where I can get all my patients’ information in real time, at the point of care in an EHR. I want that system or service to help me monitor my patients and care about them as much as I do. I want my colleagues and medical neighbors to work together for the benefit of the folks we care for. I want us all to use the best evidence and strive for the best outcomes. I want us to get rid of all the unnecessary stuff in the system so we have the time and money to do what’s truly needed. I look forward to the day when patients, providers and payers—and electronic health record vendors—all work for the same things, engaged in making us all a healthy bunch of individuals thriving in healthy neighborhoods.

But we’re not there yet.

This will take work. We have to look for new ways to connect. We will have to be a virtual neighborhood in some ways and a physical neighborhood in others. We must be willing to value our neighbors on outcomes as well as personalities. We will have to enlist our patients in building healthy relationships, relationships that may be different than those we’re used to. But trusted relationships are the only way to succeed. After all, we’re all in this together.

What do you think? Does my utopian medical neighborhood exist? I’ll do some digging around on my own for my next athenahealth blog post…

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