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The national movement toward value-based, accountable healthcare focusing on outcomes rather than volume of services is one of the most significant health policy developments of the last decade. Nowhere is this more critical than in primary care. In value-based delivery models, care is provided via coordinated and multidisciplinary teams focused – and paid – to keep people healthy while better managing expensive chronic conditions. This is in contrast to the prevailing “fee-for-service” care delivery model where reactive episodic treatment of acute illnesses leads to enormous costs without better outcomes for patients.
My experience from caring for people in underserved areas of Cleveland tells me that providers need to deliver services beyond typical primary care – they need to coordinate transportation, address housing and food insecurity, and address behavioral health and social isolation issues. While primary care providers are on the front lines of treating patients with expensive chronic diseases such as heart failure, chronic obstructive pulmonary disease (COPD), diabetes, and kidney disease, a new model is emerging which tightly coordinates specialists while quarterbacking each patients’ comprehensive care plan.