Opinion: Finding systems of care that drive value

Opinion: Finding systems of care that drive value

By Eric Worthan

We are all health care consumers, whether paying directly or indirectly for coverage or care. In the past, many people were unaware of specific health care costs because there was little cost-sharing involved, and price transparency in health care has been limited.

Yet as patients pay higher out-of-pocket costs, they are taking a closer look at doctor and hospital bills and rightly so. The recent spotlight on facility fees for physicians employed by health systems illustrates one aspect of health care sticker shock.

We spend about $2.8 trillion a year on health care; thats almost 18 percent of our countrys gross domestic product. Not only does this hit individuals and employers in their pocketbooks, but it also diverts private and government investments from other important priorities, including education, transportation and job creation.

Both the public and private sectors must work to address this problem. The best way to meet this challenge is to find systems of care that can drive value high quality for less cost. In Colorado, there are several examples of partnerships and programs that are increasing value in health care. Many independent physician organizations are assuming positions of thought leadership, creating solutions for patients, employers, insurance companies and Medicare.

It is important for physician groups to work closely with hospital partners to deliver high-quality care efficiently. And while cooperation and collaboration are important, operating independently allows physicians to deliver the most value to their patients, while allowing the relationship between a patient and his physician to drive care.

Unfortunately, consolidation of hospital chains is also driving their acquisition of physician and specialty care practices. As hospitals employ more physicians and expand their presence in the marketplace, there are concerns about growing costs. For example, facility fees (extra charges for seeing physicians in their office) are becoming more common. This trend highlights the negative impacts of decreased competition in the marketplace, and the importance of having viable, lower-cost alternatives that ensure consumers have options for the care and treatment right for them.

The care model at Panorama Orthopedics and Spine Center is built around orthopedic and spine injuries. A physician practice with fellowship-trained sub-specialist physicians focuses on specific areas of the body or types of injury (hand, sports medicine, joint reconstruction, foot and ankle, spine care). In collaboration with community primary care and specialist physician partners, clinical pathways are being developed to manage musculoskeletal disease. This focused approach includes clinical support programs like physical therapy and advanced imaging targeted specifically for orthopedic and spine patients. Our surgical facilities, Golden Ridge Surgery Center (an outpatient surgical center) and OrthoColorado (a hospital) also only treat patients with musculoskeletal conditions. This focus makes it possible to provide the best care available to patients in a cost-effective manner.

With this type of integration, all team members from schedulers to physicians have shared goals and standards related to patient satisfaction, quality and efficiency. This fosters greater accountability and involvement, driving continuous quality improvement, while managing unnecessary cost inflation.

Integration allows health care providers to create seamless care models for all types of injuries and conditions, building collaborative care teams made up of physicians, nurses, therapist and technologists. We have also found that managing patient information through an integrated electronic medical record further enhances the performance of team members.

In addition to changing the way health care is delivered, we must change how health care is paid for. Leading independent physician organizations are important catalysts in finding new avenues for payment reform. When organizations are focused on efficiency, quality and alignment, they are also well equipped to explore new payment models that reward these values.

Private practice physician integration, which fosters collaboration and partnerships rather than fragmented care delivery models, will be the key driver for success as we work to build sustained value for patients and payers.

Eric Worthan is chief executive officer of Panorama Orthopedics and Spine Center.

Opinions communicated in Solutions represent the view of individual authors, and may not reflect the position of the University of Colorado Denver or the University of Colorado system.