Is it time to expand our notion of “medical care”?

By Scott Hultstrand, SCMA General Counsel

Is it time to expand our notion of “medical care”?

Everywhere you look these days, the buzz words “population health” show up.  Policy leaders are buying into the argument that the most effective way to treat the poor health of America’s patients is to go as far upstream as possible.  By upstream they mean we need to get to the patients before they get into your exam room.  They mean that we need to come up with innovative solutions to age-old problems like socio-economic disparities, high stress work environments, failures in education, and many other “determinants of health” that shape the welfare of our patients outside of the four walls of the clinical office and hospital.  In fact, in policy discussions both nationally and in South Carolina leaders have accepted the proposition that the care provided to patients by physicians and other health care providers influences only around 20% of the patient’s health.  The other 80% of a patient’s health is influenced by other factors.  This ratio may not have been empirically proven – it’s just an educated conjecture made by population health experts – but it is being accepted as truth by those who hold the purse strings. 

What does this mean for physicians?  It means that payers and other policy leaders who believe that 80% of a person’s health is impacted by what goes on outside of your clinical office are redesigning payment structures and reallocating resources to the 80%.  I think that physicians have a number of options in the face of this shift in thinking.  One is to do nothing.  There will always be a place for physicians.  The care that you provide is desperately needed, and that demand is not going to go away.  But if you choose to do nothing, you risk experiencing flat or declining reimbursement as the dollars shift towards the 80%.  Another option is to begin thinking about how to open up your practice to new revenue streams that are flowing to the 80%.  Whether we accept the 80% ratio or not, all physicians would agree that there are other determinants of health that affect a patient beyond the care received in the clinical setting.  I think that all physicians would also agree that they are uniquely positioned more than any other profession to actually know what to do to influence patient’s health outside of their office.  Physicians know how to heal patients better than anyone else.

This isn’t just a money grab.  While it is true that new revenue streams will be made available for physicians who decide that they want to expand their practice outside of the four walls of their office, it is also true that some of these creative ideas developed by physicians will likely have enormous impact on the health of a wide swathe of patients.  Physicians can continue to heal patients one-on-one, but they also have an opportunity to lead efforts to heal large segments of the population through innovative population health initiatives.

This kind of practice, where you continue to see patients but also manage population health outside of your four walls, is not for everyone.  And many physicians will continue to thrive under the current model.  But for those physicians who are tired of being on the hamster wheel of volume and production, and who believe that the volume train is eventually going to slow down, population health management gives physicians a new opportunity to transform into what I am calling the new physician executive.  The new physician executive is a physician who sees as many patients as he or she wants, while also managing a comprehensive team of providers and other employees who bring healing to patients both inside and outside the walls of the office.  The new physician executive will be renowned in their community for improving its health status.  The new physician executive will have time, if the inclination is there, to run for office or pursue other interests that will help further the health of the community.  Basically, the new physician executive can choose his or her own adventure rather than be dictated to by the outside forces that have become so dominating in the last few decades.  The new physician executive gets to jump off the hamster wheel and take back control of their life.  Maybe I’m way off in my vision for the future of physicians in the midst of all the uncertainty and change in our health care world, but what I foresee sure sounds a lot better to me than the alternative.  Will one of you take a few bold steps to prove me right?