The future of family medicine and primary care ain’t what it used to be

Tags: value-based, payment, fee-for-service, practice profile survey

Fast moving market changes pose challenges and opportunities for family doctors in every sector

By Tom Banning, TAFP CEO

I love a good Yogi Berra quote to start off a column and few have ever been as appropriate as this one is for family physicians today: The future ain’t what it used to be.

Changes in the health care marketplace here in Texas and across the country pose significant challenges and opportunities for our members, whether they practice in rural or metropolitan communities, regardless of where they fall on the broad spectrum of practice types. I believe addressing these changes is among the most pressing issues we face as an Academy.

Public and private payers continue to aggressively push payment reforms away from fee-for-service, which rewards physicians who deliver high volume, high-cost services, to alternative payment models and/or value-based payment designs to better manage their risk and slow health care spending growth.

While there are many different alternative payment models and value-based care strategies, primary care physicians serve as the lynchpin in transitioning our health care system to be value-based and unlocking value in our health care system. As noted in an article in Health Affairs, “Primary care clinicians are uniquely trained to diagnose and treat the vast majority of medical ailments and chronic diseases, to reduce over-treatment, and to care for the whole patient. Primary care’s value in cutting costs, preventing disease, improving patient satisfaction, and enabling individualized care based on shared decision making has been well established.”

Despite the evidence and employer interest in moving to value-based care, the transition has been painfully slow. According to a recent Rand study, physicians are still paid primarily based on volume rather than the quality and value of health care services provided. The study found that in practices owned by health systems, volume-based compensation was the most common type of base pay for more than 80% of primary-care doctors and more than 90% of specialists. Additionally, the percentage of total physician compensation based on quality and cost was just 9% for primary care providers and 5% for specialists, representing a small fraction of doctors' total compensation, which was "likely to only marginally affect physician behavior."

Today our members are at a crossroads. Health systems, which employ a significant number of family physicians, have not fully embraced value-based care. And after years of under-resourcing primary care services, many of our members in private practice simply lack the capital, tools, resources, technology, and expertise to thrive in these new alternative payment models and value-based arrangements.

Observing the value-based care vacuum, corporate America has sensed an opportunity to fill the void making primary care a hot commodity. It is likely the financial and emotional stress on practices wrought by COVID-19 will only accelerate the trends outlined below. It is too soon, however, to know if and how these trends will bolster or disrupt our existing primary care system.

  • CVS-Aetna, Walgreens, Walmart, Amazon, Optum-United Health Group, and BC/BS Texas are all opening primary care clinics, buying primary care practices and/or hiring primary care practitioners directly.
  • Private equity backed firms like Aledade, VillageMD, Agilon, Apricus, One Medical, Oak Street, ChenMed, Main Street, Cano Health and Privia are making unprecedented investments in the primary care space.
  • Other innovative, physician-led organizations, like Catalyst Health Network, are providing administrative support, in addition to clinical support tools, like care navigation and coordination services to independent primary care practices allowing those practices to remain independent and perform in value-based payment arrangements.
  • Third-party telemedicine providers — Teladoc, AmWell, MDLive, Doctor on Demand — continue to carve out a primary care niche and contract directly with health plans and employers.
  • On-site/near-site clinics — Next Level Urgent Care, Health By Design, Crossover Health, Premise Health, EverNorth — continue to grow their value-based, capitated offerings.

As a not-for-profit volunteer membership organization, TAFP has largely played the role of educator and connector. We represent family physicians in a wide variety of practice settings and capabilities.

We generally describe our membership in terms of a trimodal curve. On one end, we have members who have embraced the transition to value-based care, and on the other end we have members who want to practice as they always have. In the middle of the curve exists a large cohort of members that know change is coming, but aren’t sure how to make the transition to value or what alignment opportunities exist in their market.

Helping members across this spectrum achieve and maintain a viable and fulfilling life in family medicine is a daunting challenge, but it’s also exactly what this organization is best suited to do. Our physician leadership, our resolve, and our commitment are as strong as ever.

Here’s my ask: we need some fresh data to best serve our members as we embrace this challenge together. We have designed a brief survey to help us better understand how our active members are organized, their level of understanding of value-based care, their interest in transitioning to value-based care, and the potential impediments to value-based care they face. Please take a few minutes and complete the survey.

Thank you for your membership and your support for your patients and your community, your colleagues and your specialty.

Take the Survey →

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