Dear Friends & Colleagues,
On Friday March 27th 2020, I launched a limited podcast series addressing how the COVID-19 pandemic is reframing American healthcare. You can find the introduction episode here.
Our guest this week is Dr. Chris Chen, who is the CEO of ChenMed. Dr. Chen is a board-certified cardiologist and internal medicine physician. HIs professional journey and the story of ChenMed is a remarkable one – a story of the compassionate redesign of healthcare for the older, the poorer and the sicker. You can hear more about their story in a previous interview I recorded with Dr. Chen – Episode #38 (May 17, 2018) on ‘Creating a New Healthcare’.
There are a number of critically important implications for US healthcare that emerge from this interview. What’s clear from this conversation is that ChenMed has developed and honed a sophisticated, comprehensive model of care that is allowing it to thrive in the current pandemic – while most other primary and specialty care practices are struggling. What’s also clear is that this model provides a VIP care experience for those with complex medical and psychosocial conditions, and delivers health and cost outcomes that are superior to the vast majority of provider groups and hospital systems across the country.
What’s most critical to take away from this conversation, IMO, is the understanding that the capitated payment model that ChenMed has been built upon has allowed it to develop a proactive, preventive, primary care approach that is best-in-class, resilient, remarkably innovative, and most importantly – relationship-centered and humanistic. What’s also critical to take away from this conversation is the understanding that the predominant fee-for-service payment model has: (1) decimated primary care; (2) led to severe disparities; and (3) limited the ability of well-meaning professionals to deliver the type of compassionate, competent care they were trained to and want to deliver. What I realized during the course of this conversation is that you can’t put a CPT code on ‘caring’ – and that is the fundamental flaw with fee-for-service payment in primary care. Another important lesson to be gleaned from this interview is that fee-for-service payment has rendered our system of healthcare fragile, vulnerable, and inequitable – all of which have been revealed and exacerbated by the COVID-19 pandemic.
It will be important to translate these understandings into meaningful action. Healthcare leaders must (in the aftermath of the pandemic surge) address this issue of payment; and push for a more rapid conversion to value-based payment models. This will not only serve our patients and our public health; but also allow providers and healthcare systems to be less vulnerable in the future. This is not the only fix, by any means. It’s apparent that there are other reframes that need to occur, such as redesigns in clinical care models – in the use of virtual & digital health technologies; in the use of remote patient monitoring; in the use of data analytics & machine learning; in the deployment of other less costly, more accessible approaches to healthcare; and in the adoption of a consumer-centric mindset. It’s apparent that our business models and operational approaches will require reframing as well. Having said all that, payment is still the fundamental “but” that has prevented us from unleashing the tremendous value locked up in our healthcare system for the past many decades. If this pandemic has taught us nothing else, it’s taught us that we must remove the fee-for-service “but” from our primary care and public healthcare lexicon.
In ‘Reframing Healthcare’ I wrote, “It’s clear that the current predominant system of payment – fee-for-service – provides a perverse incentive to do more” [unnecessary, costly and potentially harmful testing, procedures & surgeries]. What’s also now clear to me is that fee-for-service payment provides a perverse incentive to do less – less caring & compassion, less proactive outreach, less prevention, less equitable care, less of all the right things that we would want for ourselves, our families, our communities, and our patients. The need to transition out of fee-for-service should be one of the first lessons discussed, and one of the first set of responses deployed in the post COVID-19 era.
Until next time, be safe and be well,
Zeev Neuwirth MD