How Can PEPC Improve Care Coordination

With accountable care and risk-based payment models becoming increasingly common, a new group has announced its intention to ensure independent physicians maintain a strong voice during the shift to risk-based models. The Partnership to Empower Physician-Led Care (PEPC) seeks to promote the role of independent physicians as necessary partners in the transition to accountable care. The partnership founding members include Medical Group Management Association (MGMA), the American Academy of Family Physicians, and three state medical associations.

With independent physicians making up nearly half of the physician workforce, they are a key stakeholder for any model of healthcare delivery or reimbursement reform. Independent physician practices already have a demonstrated track record of delivering high-quality healthcare at a lower cost. For example, a 2014 study found that physician-owned practices had 33% fewer preventable patient readmissions. A different study reviewing the outcomes of accountable care programs found that nearly half of physician-only ACOs achieved shared savings, thus demonstrating the ability to control costs while achieving high-quality outcomes. This achievement rate was nearly double the rate of other ACOs.

As new care models evolve, it is often independent physicians who take a leading role in delivering care under these revised models. Independent physicians are often on the “front lines” of practicing medicine and are uniquely positioned to engage in the increased level of care coordination required under shared risk models. Independent physicians are ideally situated to take the lead in coordinating care with other physicians, behavioral health providers, and community providers.

Additionally, physicians closest to the patient are typically in a better position to diagnose needs that extend beyond the parameters of traditional medical care, such as needs involving housing, food security, substance abuse, employment, transportation, or home life. Directly addressing these social determinants of health has proven to be an effective method to improve overall health outcomes — an important metric under risk-based reimbursement models.

Improving care coordination among medical and community providers is frequently cited as one of the major aims of accountable care organizations. In fact, enhanced care coordination is one of the key mechanisms that enable ACO groups to achieve quality outcomes at lower cost, thus reaping the benefit of shared savings. By increasing the amount of collaboration across providers and by improving the nature of the care coordination itself, providers of all types stand a much better chance at succeeding under shared-risk reimbursement models.

With the shift toward value-based care, accountable care, pay for quality, and other risk-based reimbursement methods, independent physicians have a key role to play in leading the transition to alternative payment models. Given their close relationship with patients and their unique position to spearhead care coordination across provider groups, independent physicians can advocate on behalf of the patient while also attaining the quality and cost goals of shared risk models.

It is encouraging to see groups like PEPC step forward to advocate for providers and patients in value-based care models. PEPC’s commitment to reduce costs, improve quality, and empower patients and physicians is a worthwhile cause. Adding improved care coordination to PEPC’s list of desired outcomes would provide an additional worthwhile goal while also firmly establishing the mechanism that will help providers achieve the group’s other goals.

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