Physicians’ Broader Vision for the Center For Medicare and Medicaid Innovation’s Future: Look Upstream

Ray W, Norbeck T
Source: Health Affairs
Publication Year: 2018
Patient Need Addressed: Care Coordination/Management, Homelessness/housing, Patient satisfaction/engagement
Population Focus: Medicaid beneficiaries
Intervention Type: Service redesign
Type of Literature: White

Medical care, it turns out, doesn’t always lead to better health.
That may sound like a radical statement coming from an organization representing physicians, but we believe it’s time to broaden our notion of health if we want to truly care for the nation’s patients. Instead of just treating and managing illness, we envision a healthcare system that moves beyond the doctor’s office and supports other crucial patient needs—such as food and housing. We think this common-sense approach—which leads to even higher-quality care at reduced cost with improved outcomes—is shared by doctors across state lines and political persuasions.

Insights Results

Overview of article

  • This article outlines strategies that physicians can take to integrate patient social needs into their care

Key takeaways/implications

  • There are 3 ways to address these social comorbidities in a way that demonstrates a real commitment to a patient- and community-focused health system: 1) Recognize the impact of poverty and other health-related social needs as a guiding principle for how care is designed and delivered; 2) Improve care delivery and reduce regulatory burdens faced by physicians by simplifying and consolidating payment and care delivery models, using the lens of patients’ health-related social needs; and 3) Support state-level innovation that incentivizes plans and physicians to meaningfully support beneficiaries with health-related social needs
  • Instead of developing multiple accountable care organization models (e.g., specialty, rural, and Medicaid) or separate models addressing patients’ social needs (e.g., accountable health communities), all future delivery models should make social needs integral to everything from risk-stratification to cost benchmarks to quality measures+Q166
  • Physicians can be a gateway to the basic resources their patients need to be healthy, yet this role generally goes uncompensated and adds to their administrative burden because the health system is still designed primarily to treat acute illness. In value-based payment schemes, physicians often end up bearing yet greater financial risk (and poor performance on quality measures) when their patients are readmitted or require more complex care because the underlying issue is their social circumstance. This imbalance should be addressed in future models when considering the physician role
  • The Medicaid Section 1115 waivers provide states with considerable flexibility in how they operate their programs, both with respect to the delivery of care and the financing of those services. The Innovation Center would send a powerful signal to the market by prioritizing Section 1115 waivers that address screening patients for unmet social needs, include health-related flexible supports (such as funding for transitional housing), and enable broader care team approaches (such as reimbursing community health workers) without shifting resources away from physician practices that often play a central role in coordination of community services