Information = Power

As we prepare to migrate from a fee-for-service to “value-based payment” model, it is critical that we gather as much information about the care we currently deliver, so we can best prepare for the future. The more information that comes in the form of data we can act on, the more power we have. Don’t feel discouraged and try to hide from change, thinking it may never come. Take a deep breath, arm yourself with information, and embrace the power we can wield!

This became very clear after spending a few hours with like-minded colleagues at a seminar held by one of our major payers. For years they have been trying to incentivize us with pay-for-performance bonus dollars based on quality. In pediatrics, much of that quality comes in the form of well visits according to Bright Futures schedules and immunizations. I’ve spent the past five years perfecting my repeatable high performance using recall systems and QI projects to make my practice a shining example of how this can be done with the right software. Functionality and reports that provide you with the right information about which of your patients are overdue, currently due or coming due for care and a way to act on that information are the keys to success.

Now the payers are getting serious about paying us for reducing the total cost of care for our patient population. This makes most practices either feel deflated or defensive. They ask, “why is it our responsibility to bring down the total cost of care?” I would argue that everyone in the healthcare system should be “good stewards” of the healthcare dollar. Ultimately, we all pay for increasing healthcare costs, and everyone should do their part. However, this is really hard without good information you can act on.

Let’s start with prescription medications. We all know that in many cases there are generic equivalents that are equal in efficacy to the brand-name products. We also know that pharmaceutical companies often “tweak” medication ingredients in order to prolong their patent life and maximize market share. (I can’t wait until there is finally a generic HFA albuterol inhaler and all of our patients with asthma can get their needed medications at a significantly reduced price.) So, what can we do about medications? Be conscious of formularies as well as cost differences at your local pharmacies. Use generic products when prescribing as much as possible (set up your favorites so these are easy to find and choose).

Patients sometimes ask for me to refill a prescription that was originally written by a specialist. What am I supposed to do if it’s not on formulary or the most cost-effective medication for our mutual patient? Well, that same payer is starting to give us reports about our medications for which they believe we could have reduced the cost to the healthcare system. They have also agreed to inform us who the original prescriber was. So here’s where our power comes into play once we have this information. I’ve called up the errant specialist and had a very interesting conversation about why they are choosing such expensive medications. In many cases this was not even on their radar. So we agree on some basic ideas about medication prescribing and I resolve to “call them on it” if I think they are making suboptimal choices. I found the specialists in my area who are willing to engage in these kinds of conversations, and in return have agreed to send more patients their way.

Information about how much procedures cost at varying regional entities is very powerful. My adult colleagues are getting a report on cost effective places to refer patients for colonoscopies, joint replacement, etc. They are finding out comparatively how much more expensive hospital based procedures are when compared to outpatient surgery centers. In addition, many of these procedures come with true outcome based quality measures.

If you can get information about quality outcomes and cost, you have a great start to look at value-based care. And who has the power to initiate change? The person who has the relationship with the patient……that’s you! Use the power of your information to make value-based choices and you will be positioning yourself to be successful in today’s payer landscape and into the future….whatever it may hold.


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