Innovative Care Models Hold Promise for Workforce Challenges

By Clese Erikson

For the past seven years, I have focused on calling attention to expected physician shortages, tolling a fairly doom-and-gloom message. But I’m increasingly hopeful that a new message might emerge if the innovative care models currently being piloted bloom more universally.

As a researcher, it’s hard not to get excited about the workforce implications of the increased focus on team-based care, recent announcements that some insurance companies are paying more for medical home models, the potential outcomes of the Pioneer Accountable Care Organizations (ACOs) , “hot spotting”high utilization areas and targeting resources to those communities, payment bundling efforts, and the thousands of applications for the CMMI Innovation Challenge awards.

All of these initiatives have the potential to increase care coordination, improve quality, and reduce hospitalizations and emergency room visits. Most rely heavily on rethinking the roles of existing care team members and ensuring that everyone is practicing at the top of their profession. Additionally, many practices are identifying new team members and integrating home health aides, case managers, and other care coordinators into their delivery models in new and exciting ways, such as coordinating with local community programs and providing home services, that will help patients gain better understanding of their treatment plans and medications, make community resources available to them, and help them receive better care coordination.

It is important to get under the hood of these care models and truly understand the workforce implications. While some of these initiatives might end up being more resource-intensive in terms of primary care physicians, they also might result in decreased demand for specialists down the road. For example, I have been following Group Health’s move to a team-based primary care medical home model. They have seen dramatic improvements in quality of care and have decreased hospitalizations and emergency room visits. To achieve these impressive results, they decreased their primary care patient panel size from 2,300 to 1,800 and increased the average visit length.

Before delving into workforce issues at the AAMC, I worked on quality improvement initiatives that seemed to be isolated in a few vanguard organizations and were often implemented as a result of efforts by individual champions. I am increasingly optimistic that delivery models currently deemed “innovative” will become common practice and market forces will provide incentives rather than obstacles. I am also hopeful that the new and expanded roles for health care team members these types of programs promote will play a large role in mitigating expected physician shortages. The Center for Workforce Studies will be carefully examining these new delivery models with the goal of identifying those with the greatest potential for addressing workforce shortages.  I can hardly wait to see which innovations will take root and what it will all mean in terms of ensuring access to high quality care for all.

—Clese Erikson is Director of the Center for Workforce Studies at the Association of American Medical Colleges. She can be reached at cerikson@aamc.org.

0 thoughts on “Innovative Care Models Hold Promise for Workforce Challenges

  1. The simple anwesr is Freedom of Choice. First of all you must understand that there is a great deal of fraud involved with Government run Medicare. Scam artists regularly milk Medicare out of BILLIONS of dollars. Private insurance companies are out to make a profit and therefore investigate the claims much better.It should also be noted that Medicare has approx $1100 deductible each year for hospital coverage and $162 per year for Outpatient deductible. After that the member is responsible for 20% co-insurance. Add to that the fact that there is no routine dental coverage, no routine vision coverage and no prescription drug coverage.Private plans are requires by law to follow federal guidelines that either meet or exceed original Medicare coverage. Most of them far exceed these guidelines. Many plans offer dental, vision part d coverage and even health and wellness, transportation and/or fitness classes (health club memberships)The private insurance companies receive a set monthly per member fee as determined by our federal government and not a percentage. If this amount is less than the cost of care for a certain individual the insurance company is liable to pay with no additional reimbursement.Insurance is actually defined as pure-risk but closely monitored by underwriters. They have an idea of what health care costs but there are so many variables that there is no clear cut number that can actually be obtained. It is all based upon estimates.Private insurance competes for more business and thus offers additional benefits and lower co-payments in order to entice more people to join their plan. We can all keep blaming the big bad insurance companies or give the reigns over to the government who will dictate what we deserve and what they feel we need. What a novel idea. Our government thinks they are more intelligent than we are and has decided that we are too stupid to decide what is best for ourselves.With all of that being said. Everyone still has a choice to have original Medicare or choose a private plan. Medicare advantage is growing at an incredible pace and there are over 11 million seniors and growing who have made this choice. I will side with Seniors on this one. They know what works because they use these programs every day. Not everyone will ever have the same opinion but the overwhelming majority of seniors will tell you quit screwing with my Medicare They like what they have

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