What is “quality” healthcare?
by Christina Onolaja, MHA
Merriam-Webster defines quality as the “degree of excellence”. So how do we define the degree of excellence in healthcare? What does quality healthcare look like? This answer can vary depending upon who is asked the question.
An insurance carrier might say quality is defined by a patient receiving appropriate wellness visits, preventive screenings, and testing on a regular basis. Healthcare providers might say it is regular visits with their patients where they address the needs of their patients, resulting in a healthy individual. Patients might have another completely different perspective, defining quality as care that is convenient, low-cost, and addresses all of their wellness needs and concerns with compassion.
The challenge healthcare is faced with today is aligning these definitions to meet the needs of the insurance company, healthcare provider, and patients at the same time.
Jonathan Hart, MD MBA discusses in his Business of Primary Care article, The Intersection of FFS and VBC Medicine: AWV APV APPE, the benefits of preventive care visits. Annual Wellness visit for Medicare (AWV), Annual Preventive Visits for commercial plans (APV), and Annual Preventive Physical Exams for Medicare advantage plans (APPE) aid in identifying and addressing chronic conditions or other potentially preventable health concerns. For these visits to be successful, it is important for patients and healthcare providers to understand the non-monetary value.
To align the three stakeholders in their definitions of quality, an annual visit with a patient would be significantly more comprehensive than it is today in most cases. For a Medicare patient, this could involve an AWV, annual physical exam, and addressing a problem or concern in a single visit. Insurance rules have made it challenging to conduct these three distinct services in a single visit, potentially resulting in additional fees for the patient due to copays and deductibles. However, breaking these visits out separately results in patient inconvenience, reduced access to care for other patients, and unnecessary time and costs.
It’s time to get innovative and creative to solve this problem. The old way isn’t working anymore, so we need to identify what is broken and allow ourselves to make changes that disrupt the industry. Primary care providers cannot provide “quality” healthcare to patients within the confines of a volume-based care model and they certainly cannot do it on their own.
We need to step back and look at healthcare from a patient-centered viewpoint and focus more on total quality from all perspectives rather than just a financial impact. But how do we do that with the system as it is today? We need to stop only looking at what each insurance carrier requires and also consider what the patient needs.
In the next few weeks, we will break down each area where change needs to occur to bring alignment to the insurance carrier, healthcare provider, and patient understanding of quality healthcare. We will evaluate the processes, tools, technologies, and care team models proven to support a more complete, high-quality, healthcare experience for patients that is sustainable for primary care providers. Next week, we will start by discussing how the provider schedule template impacts quality healthcare and the patient experience.
