Happier doctors, better care, fewer ER visits – the upside of value-based care

While it might have been common, not so long ago, for an enterprising physician to see as many patients as possible in a single day, pure volume doesn’t necessarily produce the best results for patients – or doctors themselves, for that matter. 

David Hatfield, DO, MMM and owner of Hatfield Medical Group, recently spoke to MGMA Sr. Editor Daniel Williams on the MGMA Insights podcast about the work/life/income balance he’s managed to achieve for his practice as it’s transitioned to a value-based care model.  

Hatfield runs a family practice medical group in suburban Phoenix that has 16 providers and was started by his father in the late 1960s. He said his own experience in medicine and some of the disconnects he’s felt throughout his career have helped color his enthusiasm for a shift to value-based care rather than an old-fashioned fee-for-service model.

“You go through your training, and all you ever hear is that you’re preparing to deliver patient care and take care of people, but you never really talked about how you’re going to get paid to do that,” Hatfield said. “When I got out of my residency training, it was very much a world of high-volume, how many patients you would see in a day, how high could you bill for those patients? There was this fee-for-service, churn-and-burn mentality built on physicians that came out of school that had quite a bit of debt load and (ended up) seeing patients in a lightning quick routine.”

The results, he said, were physician burnout and general unhappiness with their profession, plus a level of patient dissatisfaction. No one was winning.

“Even though physicians were being paid well, we knew that we had to move at a slower pace and align our contracts with more value and more quality,” Hatfield said. “Thankfully, about the time that we were really starting to struggle, that’s when you really started to see payers want to align with medical groups like ours in a more value-based model – which is just providing higher-quality and better access to care and getting population health metrics embedded in your practice, getting the patient the right care in the right place at the right time.”

Slow and steady

Hatfield was first introduced to the notion of value-based care by Humana. That initial contract, he said, gave his medical group a solid, hands-on opportunity to see the challenges but embrace the notions of a slower, more nuanced approach to healthcare.

“The most important (part) was going to be provider well-being,” Hatfield said. ”Our providers needed to stop working at the pace they were and start spending more time with the patient. That allows you to address all their chronic disease conditions and to document them to make sure we are treating them appropriately. Sometimes that’s not necessarily you taking the ball and running with it but getting them to the right specialists that can handle that care.”

He said the results were almost immediate.

“It started out with one little simple contract, but it quickly moved like a wildfire when we saw that it was the right way to practice medicine,” Hatfield said. “Our providers were also giving us feedback that they wanted more time with the patients, to document the visit better. As we did that, we were able to bill, the E&M codes were a little higher and we ended up reducing total medical spend – and we were able to get some of that savings by keeping people out of the hospital.”

‘If you build it, they will come’

Hatfield admitted that the initial move to a value-based model may produce some initial hiccups with payers but said those too can be mitigated.

“Medical groups will implement a lot of the strategies and a lot of the levers to put value-based principles in their practice before they get paid, and that is hard to do,” he said. “You have to trust it, that if you do, the money will come. You have to do it like ‘Field of Dreams.’ If you build it, they will come. And honest to goodness, that’s what we did.” 

In his case, Hatfield said his group was able to build on a single contract and convince other payers of the broader benefits to patients and physician/medical teams alike. 

“When you take that story to the payers and say you’ve created access to care, we have chronic care managers, we’re reaching out to our patients that are winding up in the ER frequently, we’re doing annual wellness visits for our Medicare-age population – when you do all those things and implement them in your practice, payers will take notice,” he said. “They have to, because they’re all dying to find groups that will play in the sandbox with them.” 

The transition transformation

Hatfield said the biggest takeaway about a transition to value-based care is that it can and will happen successfully, with broad benefits to every member of your team. Doing so requires a full commitment to change, but he suggested the results can be absolutely transformative.

“Your provider and your care teams, all the way from the owner or CEO of the medical group to the person that’s managing your front desk, will see a shift in culture and a shift in care team well-being that they never could have imagined,” Hatfield said. “The cynicism will go away. The dreading your workday will go away. The biggest thing people need to do is commit.”

Hear David Hatfield talk about value-based care starting at the 26:30 mark of this MGMA Insights podcast


ADDITIONAL RESOURCES:

• "Embracing risk to succeed in value-based care" (MGMA Insight Article)