Guest Blog by Christine Hahn, UConn MPH Student

Getting More From our Health Care: Changing From Volume to Value

By Christine Hahn

Health care reimbursement in America is changing. What was once deemed innovative and cost-effective is taking a left hand turn. This evolution has been influenced by several factors, including increased costs caused by an aging population, an increase in the number of patients with multiple chronic conditions, and improvements in health care technology. Additionally, the Affordable Care Act (ACA) brought about multiple changes in the way physicians are paid, necessitating a change of focus.

The shift in how physicians are being reimbursed is known as a change from “volume to value.” What does this mean? Volume in this case refers to physicians being reimbursed for each individual service they provide (fee-for-service payment system). Value-based care, also known as total cost of care or pay-for-value, is the system that is on the horizon.

Drivers of the shift from volume to value include economic and social changes; each change requires us to prepare now for a model that will reimburse physicians for outcomes and efficiency or value, not volume. Economic drivers include the rising costs of health care. This has been influenced by a host of factors, but most glaringly includes misaligned incentives for physicians and waste.  Many argue that the fee-for-service payment reimbursement model encourages excessive and redundant care and leads to overall waste in the healthcare system. The value focus is different, in that the physician is paid for the length of care episode (e.g. per visit), not per test, lab, etc.

Social realities also play a role in the need to focus on value.  For example, the normal lifestyle for many Americans is sedentary, coupled with a diet high in fat. This lifestyle has contributed to a rising obese population. Obesity increases the risk of disease, in turn increasing health care costs. Special focus paid to this patient population over the course of their life can help reduce addition disease, such as heart attacks, in turn decreasing costs. Other social variables include the increased number of insured patients and a decreased supply of primary care physicians. Societal factors are important because they impact the way the health care system functions and therefore must be considered when redesigning a reimbursement model.

As previously stated, the overarching goal of the volume to value shift is to adopt a payment model that rewards value and eliminates waste. One way Connecticut’s health centers are doing this is by adopting the use of the Patient Centered Medical Home (PCMH) model. PCMH is a way that health centers and primary care practices can structure their care, with a focus on improving health care quality, continuity, and coordination. Continuity refers to patients seeing the same providers when he or she visits the office. A team of health care providers (physician, nurse practitioner, nutritionist, and other specialists) are dedicated to each patient, and follow him/her throughout the entirety of his/her time with that health center or practice. A focus on coordination is meant to increase communication between team members and with the patient, also improving the level of supports to the care team, such as patient follow-up and improvements in referral systems. Continuity of care is also designed to decrease errors, such as duplicating medication orders. Stitched into the core fabric of PCMH are prevention services. Preventing illnesses and complications is a major way to improve the quality of life for our patients while decreasing the costs of care; it truly is a win-win. While not all of Connecticut’s health centers have adopted the PCMH model, most (9 of 14) are already designated as PCMH – with more coming on board soon – making Connecticut a pioneer among fellow states.

The transition from volume to value comes with challenges, indicative of any major change. Admittedly, it will take time, but with collaboration and commitment this change will be transformative. This change is our future.

Christine Hahn is a graduate student studying Public Health at the University of Connecticut.

Guest Blog by Sheri Pascal, Community HealthCorps Member

Community HealthCorps member Caitlin Comfort assists with arts and crafts activities at the Peabody Museum in New Haven on Sunday, January 19 in honor of MLK Day.

Community HealthCorps member Caitlin Comfort assists with arts and crafts activities at the Peabody Museum in New Haven on Sunday, January 19 in honor of MLK Day.

 

What an exciting weekend! Martin Luther King, JR. would be very proud of how we answered “What are you doing for others?” On Sunday, January 19, AmeriCorps HealthCorps welcomed 17 volunteers and served approximately 220 children, at the Peabody Museum in New Haven. HealthCorps members assisted the children with activities relating to recycling, the environment, equality, and MLK quotations.  On Monday, January 20, 13 HealthCorps members joined with UConn Health Center Students to lead craft projects for more than 1000 kids at the Wadsworth Atheneum in Hartford.  Our small group helped decorate votive candle holders, which we used during a procession throughout the museum. We sang “This Little Light of Mine” and “We Shall Overcome”.  The museum also offered a feed of the MLK Dream Speech and a play. It was gratifying to see so many people celebrating the life and legacy of Martin Luther King, Jr.

Community HealthCorps Member Sheri Pascal serves at United Community & Family Services.

Guest Blog by Dr. Mehul Dalal, Chronic Disease Director at DPH

I used to see patients in safety net primary care in New Haven and New York City. Many of you doing this work will know what I mean when I say that your patients are complex – and they are complex in sometimes unimaginably complicated ways. You have little control what happens after your patient walks out the door. What they do and what happens to them outside the office will affect their health profoundly and it’s easy to feel what happens in the office will have little impact. This is why the work is challenging and it always will be.

Although I no longer see patients, I’m still a doctor. Instead of evaluating and treating patients one at a time, I now work with a team of dedicated public health professionals to evaluate and treat populations. Put another way, it is our job to support providers in keeping their patients healthy even when they are not in the office.

Our chronic disease team here at the Department of Public Health recently received a 5-year grant from the CDC to prevent and control chronic diseases in Connecticut. (Learn more here). This grant offers us opportunity to work with federally-qualified health centers and other collaborators to address the entire spectrum of chronic disease. We all know prevention starts early, so we’re working with our colleagues at the State Department of Education to create healthy environments for children and instill healthy habits early on. We’re working with communities to create better opportunities for walking and biking. We also hope to work with health centers and CHCACT to address common clinical and public health priorities such as hypertension and diabetes.

One part of the work that we’re particularly excited about is looking at ways to bring community resources to bear in a coordinated way to help achieve the outcomes providers want and their patients deserve. For example, we plan to work with UCONN School of Pharmacy to implement an evidence-based program that involves pharmacists in chronic disease management.

I don’t have to reiterate that all of this work is challenging, will require collaboration and working through some tough questions together. Results take time and are part of the “long game”, so please consider our team as part of your team.

I invite you to learn more about our programs by contacting me at mehul.dalal@ct.gov or visiting our website @ www.ct.gov/dph

Dr. Mehul Dalal is the Chronic Disease Director at the Connecticut Department of Public Health and previously worked at Fair Haven Community Health Center in New Haven and Bellevue Hospital in New York City.

Interview with Jesse White-Fresé, CT Association of School-Based Health Centers: CASBHC’s New Website

In early November, Jesse White-Fresé, Executive Director of the CT Association of School-Based Health Centers (CASBHC), joined us to share her thoughts and visions for CASBHC’s newly redesigned website. Be sure to check out the new www.ctschoolhealth.org for yourself!

UConn and Quinnipiac Celebrate National Primary Care Week – October 19-25

This is a guest post by Shannon McClure, Program Coordinator for the Connecticut Area Health Education Center (AHEC) Network.

Shannon McClure

Shannon McClure

With anticipation we all await the rollout of Access Health Connecticut and wonder how it will change the face of primary care in the state. How are we to handle this explosion of primary care needs? How will it impact my practice? Many of us have our shirt sleeves rolled up and ready to go for this change and others are already neck deep in it. It’s in preparation of this huge health care access overhaul, that it’s good to refocus and readjust our lenses a bit and celebrate the profession of primary health care and its value to systems change.

To do that, Connecticut AHEC and students and faculty from the UConn health profession schools as well as Quinnipiac University have planned a weeklong celebration of the value of primary health care. We are giving a voice to people, families, communities that are in desperate need of primary care access, a voice to our learning communities wherein primary care is silenced and undervalued, a voice for our own futures in primary care and have it be value by financial institutions.

Primary care is the future. It is the place where we can achieve the triple aim – better health, better care and lower cost. It is the place where patient centered medical home will perpetuate. The lay of the land is all changing and our health care educational institutions need to change the culture to promote primary care. No longer will lucrative specialties lure all medical students away from primary care. Priorities will need to change and carve a path for students pursuing family medicine, internal medicine, pediatrics, and other primary care practice.

With that UConn and Quinnipiac University celebrate National Primary Care Week on October 19-25. Events include an afternoon of service, four lunch and learn seminars, a kick off dinner, and a retreat in the Berkshires. For more information about these events, please contact the CT AHEC Network via Shannon McClure at smcclure@uchc.edu. We hope to see you there!