From Volume to Value

A quiet revolution is taking place in the health care field, and it has the potential to improve both the quality and affordability of care in this country and here in the Capital Region.

Value-based care is a system that pays doctors based on the quality of services provided to patients. Currently, our health care system operates through a fee-for-service system, which means that doctors are rewarded based on the number of patients they see. Research shows that fee-for-service often means more tests and higher costs and not necessarily better care.

These challenges prompted some health insurers to develop new models of care called patient-centered medical homes (PCMHs), which emphasize quality over quantity.

In 2008, CDPHP implemented its own PCMH called the Enhanced Primary Care (EPC) initiative. The program abandoned the “fee-for-service” model, which has historically reduced the amount of time doctors are able to spend with patients. Instead, EPC rewards doctors for spending more time with patients with the greatest needs.

Early results have shown an increase in patient and physician satisfaction, a reduction in ER visits, as well as improved clinical quality scores. Furthermore, upfront investments in these initiatives are often recouped due to fewer ER and urgent care visits.

More About the CDPHP EPC Program

Our EPC practices are designed to treat the whole patient and improve their experience of care. This is accomplished through electronic health records, convenient appointments, and access to the right medical professionals at the right time. You can find an EPC location near you by using our Find-A-Doc search tool. EPC providers are indicated by a green “home” symbol.

The goal of the EPC program is to put more focus on disease prevention and chronic care coordination. Since it was first implemented in 2008, the program has grown to include 200 practices and about 900 clinicians.

The following results have been noted:

• More than 200,000 CDPHP members visit an EPC practice
• 15 percent reduction in inpatient admissions
• 9 percent reduction in emergency room visits

The Capital Region is home to a wealth of health care, university, and financial institutions. Thus, I believe that we can work together to move toward a pay-for-value system that will benefit providers, employers, and patients and ultimately improve health care while reducing costs.