- From capturing patient risk to meeting quality measures, providers face a daunting list of items needed to achieve the Triple Aim of value-based care. But healthcare organizations will not see lasting cost savings and care quality improvements until leaders address physician burnout and move to the Quadruple Aim, Reliant Medical Group’s President and CEO explained at the second annual Value-Based Care Summit in Boston.
“The very folks who you are asking to help change the system are telling you that they want to stop. That’s a really big problem,” Tarek Elsawy, MD, FACP, told attendees. “The reality is this, in order to actually succeed at risk you’re making those very folks who are unhappy and disengaged have to do a whole bunch of stuff.”
Unfortunately, that whole bunch of value-based care capabilities and tasks are still required to achieve the Triple Aim despite physician burnout.
Healthcare organizations still need to invest in population health management infrastructure, sophisticated data analytics tools, and EHR capabilities. Using these technologies, organizations need to ensure providers are capturing quality measures, risk, codes, and a myriad of other data points.
“We’re telling providers to code stuff they don’t really understand,” Elsawy stated. “Make sure you capture risk scores. Make sure you check all the boxes for meaningful use. Make sure you do all this stuff for your local hospital and physician group measures. Have a great day. By the way, try to do a good job taking care of patients.”
Providers may even believe that certain measures or data collection efforts do not add value. However, failing to gather and report the information would jeopardize value-based revenue.
“The more non-value-adding work you ask providers to do, the more and more they become disengaged,” he added. “But they understand that it has to happen.”
Consequently, physician burnout rates are on the rise, he reported. The percentage of physicians reporting burnout increased from 40 percent in 2013 to 51 percent by 2015.
Topping the list of causes of physician burnout was performing too many bureaucratic tasks. The computerization of practice, particularly through EHRs, also cracked the top five reasons.
Neglecting to address physician burnout could spell trouble for the industry. “For every percent change that you have on the burnout scale, the likelihood is extremely high that in two years that physician will decrease their FTE or retire,” Elsawy explained.
The industry also cannot afford to lose more doctors, he continued. The Association of American Medical Colleges (AAMC) recently projected the US to face a physician shortage of up to 90,000 providers by 2025.
Primary care would particularly face a physician shortage. The industry may be short by up to 31,000 primary care physicians by 2025, the AAMC estimated.
Therefore, value-based care success hinges on addressing the Quadruple Aim, which accounts for provider satisfaction in addition to improving patient experiences, delivering outcomes, and caring in the most efficient way as possible, Elsawy claimed.
Reliant Medical Group focuses on the Quadruple Aim by implementing team-based care and placing teams in shared spaces.
The medical group, which includes 27 clinical locations, spreads case workloads across teams of caregivers. The team consists of caregivers of all levels and team members share clinical and bureaucratic responsibilities.
Shared spaces is a key component to Reliant Medical Group’s team-based care approach, Elsawy added.
“What really makes team-based care work is the concept of co-location,” he elaborated. “When you’re collocated, the level of isolation goes way down. People love when you can walk down the hallway and ask the infectious disease expert who knows about this, or a dietitian who really knows about that.”
The medical group is currently building seven new facilities with the concept “patient at the center, provider at the center” as the design concept. The pilot “Model Cell” design involves a common space in the center in which providers collaborate to perform daily tasks. Exam rooms are on the sides of the team room.
At first, providers pushed back with the co-location strategy. “Telling physicians that they are not going to have their own office is like telling them I want your first born,” he told attendees. “It has singularly been one of the most difficult battles of my entire career.”
However, Elsawy pointed out that physician offices are only used 28 percent of the time. Physician time is usually spent elsewhere and the medical group did not want to waste resources and capital on space that would not be used to its full potential.
The co-location strategy also helped the medical group achieve the Triple Aim. In terms of care quality, blood pressure control and HbA1c screening measures were better than the medical group’s target after implementing co-located team-based care. Diabetes composite screenings also shot above the corporate average.
In addition, patient experience increased from about 81 percent of patients ranking the medical group as very good to 91 percent after team-based care implementation.
For the administrators in the room, Elsawy emphasized that the co-located team-based care model made financial sense. After implementation, Reliant Medical Group reduced costs below target for admits, emergency department visits, and skilled nursing facility visits per thousands.
Medicare Advantage readmissions also fell below the group’s target.
Additionally, team-based care in shared work spaces improved the key fourth aim of value-based care: improving provider satisfaction. One provider participating in the team-based care model reported that her average daily work performed after hours decreased by almost 30 minutes despite the fact that she took over 3.7 more patients.
Nurses, nurse practitioners, medical assistants, and other providers also reported significant work satisfaction improvements. In the shared environment, these providers could work with physicians in real-time, even with patients still on the phone, rather than cluttering physician inboxes with requests and waiting on responses.
Elsawy noted that providing a team-based care model and high provider satisfaction rates will attract new providers. Medical students are now learning to practice in a team-based model and healthcare organizations that use that care model will attract talent.
Showing that team-based care can alleviate administrative burdens and prevent isolation will also help organizations attract and retain new providers.
While value-based care has been a slower than expected journey, Elsawy concluded that healthcare organizations should start to embrace team-based care and a shared work environment to move the needle further away from fee-for-service.