What if you offered musculoskeletal complex care and case management (MCCCM) for high-expense patients? The setup for this might be similar to an MCC plan, with insurers incentivizing patients to see you for a committed period of time—minimum six months. I would see this as a two- or three-visit fee-for-service assessment and care plan development, with a required sign-off commitment by the patient so the insurer will waive co-pays and/or deductibles for these office services. MCCCM would require patient activation and support care services, care coordination, accessible communication and visits, as well as performance measurements toward agreed-upon goals.
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Explore This IssueNovember 2015
What if your office or network of rheumatologists became an NCQA-accredited patient-centered rheumatology practice? Would your ACO, hospital, local employers or health plans help fund the development through grants or grantees on increased fee-for-service reimbursement plus rewards for transparent reporting? This network strategy may be similar to or an add-on to the pilot program started by the Washington Rheumatology Alliance. The key seems to be the development of collaborative relationships and identification of win-win opportunities.
We are a patient-centered specialty. We take care of complex patients with multiple symptoms & multiple-organ involvement that dramatically affect their lives. Few algorithms exist for integrating all the factors we use to make care decisions.
Finally, what if you organized a group of musculoskeletal providers around your PCSP or PCMH, which offers population data analysis, tracking, care pathways and coordination, accessible early diagnosis, and comprehensive conservative care with a personalized care program for each patient? The care plan would integrate all providers’ recommendations into one plan, set performance milestones and be tailored to the patient’s phase of illness and prioritized on the basis of value (effectiveness/cost). The care activities would be billed on a fee-for-service basis. Rewards would be negotiated annually and be based on performance objectives and cost-sharing of per capita expenditures.
We start our careers in pursuit of the patient story and end the same way. In between, we try to make sense of stories we hear and create a system that allows us to be the most effective, compassionate physician we can be.26
The Robert Wood Johnson Foundation has stated that over 50% of our healthcare costs are for problems related to patient behaviors. How many patients do you see each day for whom you wished you and your team could offer more education, teach more skills, listen longer, comfort better or better support their pursuit of wellness? I have been blessed to work with a patient to better understand this journey.27 Whether a patient can be their own best-quality advocate (e.g., Alice) or doesn’t have the skills, confidence or emotional resources, each of our patients deserves the possibility of having an illness coach or advocate. I think this alone would move us significantly toward achieving the Triple Aim, but we would need to add system support based on education system principles.