kentoh - Fotolia

Physician progress to value-based care reviewed by expert

The shift from volume- to value-based reimbursement in healthcare promises to put more emphasis on positive medical outcomes, population health expert says.

Craigan Gray, M.D., is chief medical officer at New York-based management software and consulting firm Salient Management Company. He talks with SearchHealthIT about the move to value-based care, healthcare analytics and more emphasis on good medical outcomes. Gray, who holds law and business degrees, also talks about his experience running North Carolina's Medicaid program.

This is the second part of a two-part Q&A. In part one, Gray discusses the relationship between population health analytics and value-based care.

Can you talk about the new Medicare reimbursement models and MACRA, the Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act, and its emphasis on value-based care?

Craigan Gray: It was an important step, because it got rid of the antiquated payment process for physicians and resolved that annual pain that Congress and the healthcare community went through every year. It also set a value-based payment process in motion. However, there [are] still some gaps, still some problems that need to be sorted out. It's very important to shift the incentives toward better outcome-driven metrics for the physician and provider community. It focuses on the wellness, health and clinical outcomes of the individual patients that are involved.

Craigan Gray, M.D., chief medical officer, Salient Management CompanyCraigan Gray

In addition, it's letting quality pull the financial piece along. We're going to see higher utilization among office visits, with annual wellness visits and chronic care management. Those are all going to go up. Pharmacy is probably going to go up as people are prescribed the correct medications and take them, because it's being monitored that they take them. We're going to see inpatient utilization drop significantly, and the next thing, readmissions, drop significantly.

It's important that the physician community be reimbursed fairly for the new work that they are doing, and that is, they get paid for a population that stays and remains healthy and not be paid by just the number of patients they see. That's both boring and dissatisfying for the physician and not necessarily the best methodology to take care of patients.

One of the lessons I've learned is that all of the programs, and particularly mental health, must be driven by outcome metrics.
Craigan Gray, M.D.chief medical officer, Salient Management Company

What are some of the key lessons you brought with you to the private sector from running North Carolina's Medicaid program?

Gray: Running Medicaid for North Carolina was the worst, most interesting job I've ever had. Depoliticizing Medicaid would be the first step, and allowing professionals to run it, keeping the patient clearly in mind. One of the lessons I've learned is that all of the programs, and particularly mental health, must be driven by outcome metrics.

Do you think Medicaid and the states will switch over completely, at some point, to value-based care just as Medicare is in the process of doing?

Gray: Oh, yes. Look at New York and the billion-dollar program to totally shift the healthcare delivery system. Hospitals are, respectfully, no longer the center of the healthcare universe. The center of that universe is shifting inexorably toward the physician and the patient.

But nonetheless, New York is doing that. They're shifting from a totally deeper, service-based environment to managed care, then the next shift is to value-based care at the physician level, and they are driving the responsibility and the financial risk down to the provider level.

You said physicians and patients are becoming the focus of healthcare, as opposed to hospitals. Isn't it also true that healthcare systems are increasingly snapping up physician practices?

Gray: That's also true, but they're hoping to preserve their bricks and mortar, to keep things as they always have been. I'm not denigrating the importance of hospitals, but I am criticizing the fact that hospitals have risen to the center of the universe, and that they've done so because they have been profit centers, and now they have become cost centers.

One consultant calls that disintermediation. He says that the hospitals have mediated between patients, doctors and their care. And now through disintermediation, whether it's telemedicine, remote patient monitoring or patient-centered medical homes, that bricks-and-mortar approach is not as supportable as an economic model in the future.

Gray: That's correct. The idea of keep them sick and keep them coming goes away.

What stage of maturity is healthcare analytics at now?

Gray: We are in a time when health analytics can produce actionable data, rapidly achieved, that is easily used at all levels of the healthcare paradigm. It used to be that only the wonks and the Ph.D.s were able to extract data out of the databases. Nowadays, ... it's there, and if we're not using it, we do so at our own peril. Can it get better and faster, more complete? It can. It will. But right now, we have actionable data that's available at all those levels of healthcare today.

Next Steps

Healthcare CIOs put purchasing priority on analytics

More MACRA reimbursement changes

Data lakes new approach to healthcare analytics

Dig Deeper on Population health management