Health care focus shifting from volume to value of care

Vik R. Reddy

Re: the Feb. 5 op-ed in The Detroit News,Health laws’ cost-cutting and patient care priorities”: I read Ms. Sally Pipes’s article on the Affordable Care Act (ACA) and Accountable Care Organizations (ACOs) with great interest. I have been uttering the phrase “Let me check with your primary care doctor” with increasing frequency in the last several years. As a specialist, I often have patients referred to me by primary-care physicians for problems that go beyond their scope of practice.

When I started practicing medicine, close to a decade ago, I gave little thought to notifying anyone else what the plan of care was for my patients. If a patient needed an MRI of their leg, I ordered it. If I felt they needed a referral to another physician or therapist, I made it.

Now, regardless of whether a primary care physician is in the same health system I am in or not, I let them know as soon as possible. This practice goes beyond just being nice, it is the state that medicine is moving to, and those physicians and hospitals that cannot adjust will be left behind.

Pipes’s main contention is that Accountable Care Organizations, which were first developed in the ACA, are a failure that rewards organizations for cost-cutting over the quality of care. The response from health experts has been mixed with some arguing that it is a good first step while others stating that the program has systemic design flaws . I believe that there is validity to both points.

I believe that Pipes is missing the larger point in her criticism of ACOs, however, when she promotes the idea that cost-cutting is the sole driver. In truth, the implicit goal of ACOs is to provide efficient quality care.

Medicare accounted for 14 percent of the national budget in 2014 with Medicaid making up another 9 percent. Regardless of your political stripe, avoiding duplication, fragmentation, and waste in health care expenditures should be a universal goal. ACOs were designed to do this by creating networks of providers and hospitals with a shared vision of care coordination. Has it been entirely successful? Probably not. The goal, however, remains critical.

To illustrate the point, several private insurers have their own products which share similar characteristics to ACOs: creating a network of physicians, monitoring both the quality and cost of care, and rewarding the high performers.

ACOs and ACO-like organizations are an extension of population health: managing the health and wellness of a group of patients. Rather than rewarding these organizations on how much revenue they generate, the metrics change to avoiding unnecessary hospitalizations, making sure that patients receive critical screenings like colonoscopies, and a focus on prevention. The paradigm in health care is shifting from volume to the value of care.

Returning to the example of my own practice, contacting a patient’s primary care physician for such things as MRIs and referrals is an extension of these same principles of population health.

The goal is to avoid sending patients on expeditions similar to the old Family Circus cartoons where a child walks around the entire town and ends up telling his mom he was at the neighbors. Substitute a patient getting sent to multiple specialists, each one ordering different tests without coordinating the care with the primary care physician: the results are usually not optimal.

Sadly, all of us have experienced this to some degree when navigating the health care system. Beyond the financial rewards that ACOs and similar products offer to physicians and health systems, the biggest winner in all of these players of the health care continuum engaging with one another is the patient.

Vik R. Reddy, Henry Ford

Macomb Hospital