By David W. Anderson
In the eight counties of Western New York, there is one primary care physician – the doctor you first visit for most of your health care and wellness needs – for every 1,666 residents. Nationwide, there is one primary care physician per 1,250 residents.
Why does our region have fewer gatekeeper physicians helping most patients at the crucial entry point to the health care system?
Because the traditional “fee-for-service” payment model rewards more visits, something that may or may not result in high-quality, efficient and lower-cost care. By changing that model this year for 1,000 primary care physicians and their teams who serve as quarterbacks for our 400,000 BlueCross BlueShield of Western New York members, we’re improving quality, better incentivizing physicians and – the Holy Grail of health care – doing it all at lower cost.
In the traditional model, patients have to bear responsibility for their care, primary care physicians and specialists don’t generally collaborate on patient care, tests are often redundant or unnecessary, and physicians have to see patients in their office to be paid for their work and expertise. These factors lead to increased costs for patients and their employers, as well as increased administrative costs for the physician practice.
Almost 18 months ago, we started introducing a new system called BestPractice. This reimburses those 1,000 primary care physicians and their teams for the holistic care of their patients. Now the focus shifts to total patient health, patients are referred to specialists more appropriately and data is shared more effectively, rewards arrive for better patient outcomes, patients are healthier and happier, and the system results in lower costs.
How can that be? Physicians are able to practice to the top of their license (and more medical students may want to go into primary practice as a result) because the system provides a consistent cash flow that’s no longer based on erratic, seasonal, disease-based office visits.
The new system also gives primary care physicians the opportunity to increase revenue by 10 percent in 2017 and 20 percent in 2018 while still saving on costs overall.
Patients benefit because their physician cares for them beyond office visits, incorporating telephone- and internet-based interaction. Care is better coordinated, supported by advancements such as electronic medical records, and more focused on overall disease prevention and wellness, not simply treating sickness.
With BestPractice leading the way, and the cooperation and commitment of the primary care community, data shows we’re improving patient health, better motivating and incentivizing physicians, and hopefully keeping some of our region’s medical students interested in entering this important field to care for us today and tomorrow.
David W. Anderson is president and CEO of Buffalo-based HealthNow New York Inc., the parent company of BlueCross BlueShield of Western New York and BlueShield of Northeastern New York.