'Payment Reform: The Time Is Now!' by Dr. Gene Lindsey

This article is more than 12 years old.

Massachusetts is about to write the next chapter of health reform.

The Payment Reform Commission, which was established as part of our local version of health reform, has just issued its recommendations. The core recommendation is the “what’s old is new again” idea of global payments. “Global payments” are a move away from the current “fee-for-service” system where there is a constant possibility of overuse or misuse of resources because providers can be paid more by ordering more visits and procedures, and a move towards a system that gives providers the resources that are adequate to take care of “the whole patient.” The new system should also include quality measures so that patients can have confidence that the decisions made in their care are patient centered and aligned with their desire to be healthy and are not driven by the desire to save money at the expense of their health. It is critical, in fact, to create a link between quality and payment.

We have great faith in the possibilities of global payment if it is combined with a focus on quality. Atrius Health, an alliance of five medical groups including Dedham Medical Associates, Granite Medical, Harvard Vanguard Medical Associates, South Shore Medical Center, and Southboro Medical Group, has experience with the benefits that global payments offers for patients. We know from years of experience with global payment as well as our current experience with fee for service payment that global payments can help providers better allocate our limited resources towards the care that will ensure the best health outcomes for all of us.

A well-designed system based on global payment will put primary care physicians at the heart of health care, where they belong, coordinating care for the patient. We agree with the payment reform commission’s conclusion that as our physicians acquire the tools and skills needed to accept global payment, we will be getting closer to the goal of universal access to high quality affordable healthcare for every citizen of the Commonwealth.

The Payment Reform Commission has taken a bold step forward, but there remains much more work to do and many of the details will be left to a yet-to-be formed Board that will undoubtedly be the subject of heated debate about its composition and its exact charge. It will then be up to the Board to oversee formation of “Accountable Care Organizations” (ACOs) that will be at the heart of payment reform. Who gets to form an ACO will be critical because these organizations will control how the global payments are distributed. As one of the providers with the longest history of working with global payments, Atrius Health is one model of what an ACO could be. Undoubtedly there are others.

For payment reform to have a chance to succeed, we have learned that there are certain elements that need to be in place. First, there needs to be a way to connect patients to a primary care physician so that payment is made to the organization providing the care. Optimal ACO’s will need to have a scale large enough to accept the risk of providing care on a fixed budget and the expertise and appropriate infrastructure to manage risk. Smaller physician offices may find it best to partner with other groups or hospitals. An electronic medical record, access to claims data and the ability to analyze thate data are also important to ensure quality outcomes while managing cost. We believe that global payment will be more successful if all physicians have access to an infrastructure large enough to support services that support great care, such as clinical pharmacists, case managers, and nursing. The ability to provide the optimal experience and the infrastructure to succeed with global payment should be important descriptors of an ACO.

The work of those who led us to take the first step of this journey has given our Commonwealth the enormous opportunity to envision and create our own future, to improve the quality of the care available to our citizens, and to reduce the rate of growth of our health costs. Atrius Health is ready to embrace the change and help others move toward it.

Dr. Gene Lindsey,
President and CEO of Atrius Health

This program aired on July 17, 2009. The audio for this program is not available.