Dr. Chris Magryta column: How do we get people to change when they have no incentive or do not want to?

Published 12:00 am Sunday, December 20, 2020

By Dr. Chris Magryta
Rowan Pediatric Associates

The new year begins a new world of medicine for us in North Carolina. We are moving to what is called value-based care. Center for Medicare and Medicaid Services currently defines value-based care as paying for health care services in a manner that directly links performance on cost, quality and the patient’s experience of care. So the future of your provider’s reimbursement will be tied to your outcome and experience.

This, at first blush, makes for a good experiment as a happy and well-cared-for patient works for everyone. However, it takes a provider to effectively teach and encourage a patient to follow the preventative plan for a good healthy outcome. It also takes a patient to hear and follow the plan. In a perfect world, a teacher teaches and a listener listens. Only if it were so.

However, what if a patient does not follow the rules? What if they say that they are going to take their medicine, eat whole, healthy foods and exercise. Yet, their asthma and/or diabetic markers show a decline in health. The patient admits to not following the plan, a common occurrence in medicine. The provider is then informed that the patient has not achieved the goals and thus they are to be paid less.

Here begins the breakdown in the provider patient relationship that we are foreshadowing. The incentives are now officially broken for care. The provider will believe that they provided a path for success. The patient will feel that they have the right to follow the path that they choose. The outcome is a lose-lose if the health quality deteriorates. Now begins the process of providers firing patients for non-compliance or cherry picking healthy patients. What a mess.

The future is set up so that the primary care provider will be tasked with controlling costs. If a patient chooses to go to the urgent care of emergency room when the primary care office is open, the costs go up and the provider gets dinged. If the provider refers to a specialist frequently, the costs go up and the provider gets dinged. You get the picture. This system will work great if the provider teaches well how to prevent disease. This system will work great if the patient follows the rules. If either of these two facts are untrue, then this new medical delivery system will be a failure.

Actions, not words, reveal our real values. If our actions lead to a healthy successful outcome, then value-based care is going to work. If words are not followed by actions, this is the newest American medical model to struggle to control costs and improve health outcomes.

Over the past 10 years, we have thoroughly covered reams of lifestyle-based decisions that improve our health. Getting our thousands of parents and patients to read this free newsletter and/or follow prescribed plans in the office has been exceedingly difficult for the last two-plus decades.

Dr. Chris Magryta is a physician at Salisbury Pediatric Associates. Email him at newsletter@salisburypediatrics.com .

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