Congress has taken an interest in a doctor-payment model for Medicare, pioneered here by Independent Health, designed to control the growth of health care costs while improving quality of care.
Dr. Thomas J. Foels, Independent Health’s chief medical officer, recently testified before a House subcommittee in Washington on new ways to pay doctors under Medicare. Foels talked with The Buffalo News’ Brian Meyer about the insurer’s effort to help guide innovation. Here is a summary of issues in an interview that is part of the weekly “In Focus” series.
Meyer: Can we really control costs without diminishing the quality?
Foels: I think that’s the great question. I agree that we’re really interested in the sustainability of health care in the long term. So addressing the cost is a major issue. But we firmly believe that there are ways to reduce the costs and at the same time increase quality and accessibility.
Meyer: You’ve said that reforms in Medicare are best implemented locally. Tell us what you’re doing.
Foels: Congress is very, very interested in innovations that seem to be working. They want to use those as models to reform Medicare payment. So our program in particular is focused on primary care physicians as the centerpiece of that, and then builds off that with a very innovative alternative payment system.
Meyer: A lot of folks have said that a fee-based payment system is really the root of the problem.
Foels: Fee-based payments are basically a reward for ... things getting done. But it doesn’t address in any way, shape or form the value or the quality of the service. It tends to promote tests; it doesn’t promote coordination. It’s very easy in a fee-for-service world to have what we call silos
It doesn’t create teamwork across disciplines – primary to specialty, specialty to hospital.
Meyer: When we talk about delivering health care, we don’t often think about incentives for different types of care. Some might wonder if that doesn’t cheapen or in some way undermine the process.
Foels: That’s why I think Congress is very interested in our model, because it’s very balanced. There are only a handful of different payment models, and each has pros and cons. So we took several of those and emphasized the pro part, and created what we call a hybrid. It still retains a little bit of the fee-for-service for things that we would like to drive more of: preventive care visits, immunizations, in-office laboratories.
There is also a very robust recognition of the quality and outcomes that they achieve. ... A shared savings component rewards work that physicians have always done, but it has never been rewarded or recognized before. The work that they would be doing to coordinate care with specialists or working to create home-based services for patients who might otherwise wind up in the hospital. So the bundle of these things is a very nice balance, and I think it was very attractive for Congress to hear what’s actually been done and is working here in Western New York.
Meyer: Another question is whether or not the physician community is embracing this type of sea change.
Foels: We’ve had the benefit at Independent Health of working very closely with physicians in our community for years. And even then, it took some time. They wanted to really understand all the moving parts and actually be involved in the design of the program. And when that happened, they were on board.