By Michael W. Cropp
A Buffalo News editorial regarding the projected price tag for Erie County’s Medicaid program (“A $2 billion challenge,” Oct. 11) cited the transition to value-based care as one solution to transforming care and lowering the unsustainable trend of rising health care costs.
Value-based care allows health care providers to focus on the clinical care of their patient population, in particular those with more serious conditions. It also reduces many of the “extra costs” associated with the volume-based, fee-for-service model.
It’s estimated up to 40 percent of routine “sick visits” can be handled through alternative forms of care delivery between the patient and doctor, such as phone or email, in a value-based environment. With fee-for-service, the patient must go into the office in order for the physician to be reimbursed. For the patient, this typically requires time off from work, possibly resulting in lost wages, along with the added expense of a copay or deductible. It also results in lost productivity for the patient’s employer.
Value-based care empowers physicians to improve quality and efficiency to make the system work better for their patients. K. Kent Chevli, M.D., president of WNY Urology, says: “When you combine the insight of physicians on patient care delivery with the insight the health plan can provide, amazing things can happen which benefit everyone involved in the equation.”
We began working with our physician partners to adopt this new payment model several years ago. Nearly 65 percent of our members are currently aligned with a provider who is in a value-based agreement with Independent Health and that percentage will increase to approximately 90 percent in January.
The federal government is doing its part to move to value-based care by tying Medicare payments to this new payment model beginning next year and through innovative initiatives such as Comprehensive Primary Care Plus (CPC+), which seeks to strengthen primary care, improve patient and population health and lower costs.
In May, greater Buffalo was one of only four regions nationwide selected to participate in the second phase of CPC+. The collaborative efforts of Independent Health and BlueCross BlueShield of Western New York were critical in securing this selection, based largely on our alignment with CMS’ approach to alternative payment models and quality measurement.
Open to primary care providers in Erie or Niagara counties with more than 150 patients covered by original Medicare, CPC+ will begin in January 2018. Nearly 500 primary care physicians, representing 74 practice sites, will participate.
Providing federal funding to physician practices participating in CPC+ will strengthen primary care and help further transform health care in Western New York. As always, our region is on the leading edge of change, with health plans, physicians and other health providers working collaboratively to improve the quality and value of care.
Michael W. Cropp, M.D., is president and CEO of Independent Health and a board-certified family physician.