When you see your primary care doctor, nurse practitioner or specialist, you are not working with a single individual. Most often, you are working with a team. Even if they aren’t in the exam room, your clinical team is contributing to understand your case, review options and decide the best care for you.
Integrated care is the preferred approach in healthcare today. It means that all parts of the healthcare system are working together to combine their knowledge and insights to meet your needs as a patient.
The traditional healthcare system is fragmented and its parts typically don’t work together in harmony. Primary care needs to coordinate care with specialists, and specialists often must share information with their peers. Without a free flow of information, doctors might focus on just one aspect of the patient’s condition. Like the fable of the blind men and the elephant, a doctor’s perspective may be limited to one body part or bodily system, or medical vs. behavioral. No one is responsible for assembling the pieces, seeing the whole puzzle, and deciding what it all means for the patient.
Integrated healthcare, on the other hand, ensures that multiple perspectives are blended into a comprehensive diagnosis and treatment plan. As a patient, you are reassured that all views are represented and every concern addressed. The collective judgment and knowledge of the team is more powerful than a single provider.
Traditional payment models
In traditional healthcare, the most common way doctors are paid is fee for service. This means that doctors are paid for each service they perform. Like an auto mechanic, who is paid for changing the oil, rotating tires, fixing your brakes – each procedure incurs a charge.
Under fee-for-service payment, doctors may not be paid for discussing the patient’s case with with a specialist or following up after a referral. And the specialist may have minimal incentive to close the loop with the primary care doctor. These gaps in communication can cause findings to be overlooked. And poor coordination between doctors can result in substandard care and poor outcomes for the patient.
In a similar way, when a patient is admitted to the hospital, it is paid under the contracted fee structure. While the facility may provide appropriate care, it also may have an incentive to hold the patient as long as possible to maximize their own payment. At the same time, there is little financial incentive to communicate with their referring doctors or plan for the patient’s care after discharge.
Value-based care
An alternative payment approach, called value-based care, encourages teamwork and integration. Instead of being paid under a transactional model, providers receive a single bundled fee – called capitation. Under this fixed payment, providers have an incentive to keep patients well, prevent sickness and acute episodes, and keep patients away from the emergency room and hospital which are the most expensive types of care.
When providers do a great job of caring for patients and keeping them healthy, they benefit by retaining more of the capitated payment.
Under value-based care, primary care providers (PCPs) have greater importance. PCPs are on the front lines of the healthcare system, responsible for prevention and early intervention. Accordingly, there is greater emphasis on clinical teamwork and integration. When providers work together under a value-based payment model, they all have the same incentive to keep patients well and do whatever necessary to prevent sickness and hospitalization.
CareMore’s integrated care model
CareMore’s integrated care teams rely on a strong primary care foundation. Its “advanced primary care” model is led by the primary care doctor. However, the PCP isn’t alone. The PCP is supported by a local team of advanced-practice providers, nurse practitioners, nurses, specialists, pharmacists, behavioral health clinicians, social workers and community health workers.
Like the PCP, many of these providers are salaried CareMore employees. So they share the same incentives of placing the patient at the center, providing a personal, caring experience, and delivering the best possible clinical outcomes. As CareMore employees, they share the common CareMore culture and values.
Clinical integration is more than just a commitment to teamwork. CareMore provides an infrastructure that supports clinical integration. CareMore’s electronic medical record (EMR) system facilitates collaboration and shared decision making. Through the EMR, members of the clinical team have visibility to the treatment plan, encounter data, test results, medication regimen, clinician notes, etc. The EMR has embedded workflows and treatment protocols which can be referenced for disease management and evidence-based best practices.