By Dr. Jordan Asher
There has been an increased focus on the Merit-based Incentive Payment System (MIPS) that is designed to shift physician Medicare payments from fee-for-service to fee-for-value. The goal is to reward physicians based on improved performance in the domains of quality and cost containment. To date, there is a great deal of concern in the physician community that the program creates undue burden on physicians and may not accomplish its stated goals.
However, there is great excitement when we look at the current conversation through the lens of innovation. Regardless of the final regulations, the conversation has shifted. No longer are we discussing the right level of reimbursement for a given procedure. We have now pivoted to discussions concerning the metrics for value and the types of patient interventions to deliver better outcomes. We accomplish this while remembering that value has three components: quality, service and cost, and innovative opportunities abound.
If we truly want to change the interactions between providers and those they serve with the goal of increasing value, we need to focus on personal activation, and engagement will become paramount.
Historically, the focus of healthcare has been to improve a clinical condition. We inherently view our interactions through a disease-based lens. The problems we are solving are physiologic in nature and are deemed to be most important. However, our partners in these endeavors – those who we are privileged to serve – have a completely different perspective. Most people rarely think about how to solve their disease-based issue but rather on the issues of the day. Only through activation and engagement will we be able to marry the two thoughts. The innovation lies within this space. How do we connect the social sciences of human behavior to the physiologic nature of disease-based models? What are the tools and concepts in which to be successful? Innovators may look at these problems through very different perspectives than healthcare providers.
Another area ripe for innovation is self-diagnosis and management. If our goal is to create greater value, a different partnership will be required between provider and consumer. The focus of “How do I help you?” must shift to “How do I help you help yourself?” This adjustment of defining the problem needing to be solved completely changes the dynamic.
We also tend to believe that more education solves the self-help perspective. How I help myself is much more complex. “I” must first become comfortable with the reliance on myself and use external inputs for subject matter expertise. I then must have the tools to succeed. A perfect example is home pregnancy testing. As we usually don’t view pregnancy as a disease, we are comfortable with the idea of not needing to be “told I am pregnant.” Since we are comfortable with self-diagnosing, the use of a tool becomes highly desirable. There are plenty of other conditions both acute and chronic that can be managed similarly.
Access is another area that has been of great focus for innovation. The next version will be self-access, meaning the tools that can help me identify what I need and the easiest way for me to get it. Currently, we are focused on the latter component, and innovation will be required to solve for the former. The “supplier” side of healthcare and the “demand” side are not aligned with what the other wants or needs. We tend to focus on how to become a better service delivery model, when the consumer may desire an experiential and transformational experience.
As we continue to innovate in these areas, healthcare provider proficiency is ripe for disruption. Human learning sciences have progressed and innovators will embrace the connections to healthcare providers. Reducing clinical variation and harm is on the radar for all.
The current mode for problem solving is based on identification and sharing of data. Success is completely dependent on the changing of behaviors based on having such knowledge. However, addressing the root cause is a behavioral science issue, not dependent on clinical knowledge. Each day providers act based on the best interest of those they serve. If we now must confront the premise of what is core to our beliefs and actions, we will be required to “relearn” our facts and activities, and change our habits. Innovators will see this gap and create models for improvement.
For innovation to prevail, there must be problems to be solved, and those involved need catalysts for change. We are there now. Americans are demanding change, our financial environment requires change, new entrants into the market are providing change and physicians are needing to change their incentive models to meet the demands of our current healthcare landscape. Regardless of how our legislators address the issues around MIPS, change is in the wind and will continue to blow.
Jordan Asher, MD, MS, is the chief clinical officer of Ascension Care Management. His role concentrates on creating innovative models of care delivery, as well as providing national thought leadership directed towards the future of healthcare.