Clive Fields, MD is co-founder of VillageMD, a Deerfield, IL-based consulting firm that specializes in assisting primary care practices with business development, value-based contracting, and analytics-driven decision-making.
What prompted you to help found the company?
The past few years, and as far as the eye can see, will pose both challenges and opportunities for primary care physicians. The move to value-based payment and the increasing focus on wellness, prevention, and management of chronic illness is exactly what PCPs have been trained for. Success in those areas will not be easy. It will require organizational changes, the adaptation of technology, and access to capital that most physicians have no experience with. VillageMD was founded to help physicians meet those needs. Our goal is to provide PCPs with all the tools necessary to drive improved quality and cost efficiencies through the healthcare system.
What type of practices seem most attracted to the VillageMD model?
We are currently in discussions with physicians in every type of model you can imagine – independent groups seeking to remain independent, small groups looking to grow, and hospital-employed groups interested in accelerating their change to value-based contracting. We originally focused on independent physician groups interested in growing in a local market. For those we offer a complete PM solution including a robust population health infrastructure. Allowing physicians the time to do what they do best – taking care of patients – is driving this type of group to VillageMD. Large hospital groups are struggling with change just as are independent physicians. Those groups are interested in technology, work flow and our payer experience as they move towards population-based change. On the surface, the hospital-based and independent physicians seem completely different, but similar clinical goals in managing a population successfully are attracting them to VillageMD.
Our initial client was an independent group in Houston. Over the last two years we have seen that group move almost all of their commercial and Medicare patients into value-based arrangements, while at the same time growing the group size and adding two additional locations. We have also helped the Houston group grow a citywide, affiliated primary care network. In August, we announced a relationship in the Indiana market with a large hospital system providing a population health infrastructure to a large group of employed physicians. We will work to help this group move to successful implementation of value-based contracts, while at the same time helping them grow a larger geographic footprint for both their employed and affiliated physicians. We have an executive team in the Illinois and New Hampshire markets, and anticipate announcing new relationships in the near future.
How are physician practices using analytics to improve outcomes and increase access?
For physicians to be successful in this new payment model, clinical pathways will have to be focused on populations not individual patients. These should all be informed and measured with data. Nothing will ever replace the value of a physician-patient relationship, but to extend reach beyond the traditional exam room will require the use of analytics. We currently use analytics to identify utilization trends, improve quality metrics, and increase patient attribution. Physicians need to know who their patients are, what contacts they are having with the healthcare system, and what opportunities can be reasonably predicted that will improve their clinical outcomes.
How does this utilization differ from what was done just five years ago? Where do you see analytics taking primary care in the future?
For most of my career, patient contacts were limited to scheduled clinical appointments. The use and availability of data lets me identify quality gaps and clinical opportunities, and reach out proactively to help them meet their needs. Being able to identify a group of patients with poorly controlled diabetes and reach out to them with education and support, not one at a time but as a group to improve their diabetic metrics, is both clinically effective and administratively efficient.
The future in medical technology and analytics is really exciting. I believe we will see disease management and population-based data completely integrated into the EHR. The processes we use now to identify and contact high risk-patients will become automated, driving improved and efficient outcomes. This is the advance that needs to happen to move from the electronic documentation of a medical record to truly using an EHR to manage a population of patients. At VillageMD, we are moving in that direction, integrating a risk stratification tool into the EHR so that it is available at the point of contact between a physician and patient.
It seems the industry is looking to hospitals and health systems to lead the way in population health management, but I’m convinced primary care has an integral role to play. What are your thoughts?
In America we all benefit from the finest hospitals and specialty care in the world, and no change in our healthcare system should diminish that. Unfortunately, the focus on specialty care has created a fragmented and expensive system that is not economically sustainable. I believe a similar focus on improved outpatient care, in the areas of wellness, prevention, and chronic-disease management, is where the next evolution of our healthcare system will occur. No one is better suited for that role than PCPs. Controlling a patient’s diabetes and avoiding renal disease blindness and other complications should be our clinical goal. Unfortunately, the system has been focused on managing rather than avoiding those outcomes. Successful value-based contacting and population management will drive resources to those physicians skilled in the prevention of disease complications, not only in the treatment of them.
Some would argue that primary care is hard put to dig itself out of the fee-for-service trenches. How do you see healthcare technology propelling the shift towards value-based care?
The healthcare system is struggling with the move away from fee-for-service medicine, including primary care. Those physician groups that are able to make decisions quickly and use data to pivot away from failures and towards success are in the best position. Organizations with streamlined administrative structures that allow physician voices to be heard in every aspect of the organization will do well in the future. The increasing use of technology continues to identify areas where PCPs can make an impact. Utilization, quality, and patient satisfaction metrics continue to identify the PCP as the lever that can most impact all three areas.
What’s next on your clients’ plates with regards to healthcare IT projects now that Meaningful Use is winding down and ICD-10 will soon be upon us?
Our clients continue to use IT to identify areas physicians can use data to improve clinical outcomes. The integration of utilization and risk stratification data into chronic care management and transition care management program is high priority. A consistent focus is moving information out of the IT department and to the place a physician can best use it – an office visit, telephone encounter, or e-visit.
What will the next five years hold for VillageMD?
The future is incredibly bright. The move to value-based reimbursement requires skillsets not currently present in most physician groups. We believe our experience, management team, and track record of success can provide those skills for many groups in the future.
Do you have any final thoughts?
Change is hard, and anyone who says otherwise hasn’t been through it. Now is the time for PCPs to use their unique position in the healthcare system to drive the kind of results we all strive for, across populations, insurance status, and disease states. The future has never been better for PCPs.