MURRAY — Primary Care Medical Center co-founder Dr. Robert Hughes says he believes health care costs can be made more affordable.
That is why about two years ago, when he learned about a program known as VillageMD, led by the efforts of one of its three founders, Dr. Clive Fields in Houston, Texas, he looked into incorporating VillageMD’s practices into that of the Murray medical center. In doing so, PCMC became the first Kentucky establishment to try this program.
The reason, Hughes said, was simple. Fields was getting good results in Houston from a philosophy known as value-based health care. Now, after a year in the VillageMD program, Hughes said data seems to show that the VillageMD ideas have yielded positive results.
“Last year, we had three value-based contracts, and for that first one we got measurements on 4700 patients, and we drove their costs down half a million dollars,” Hughes said. “Now, did that go to the person, the insurance company, the employer? The answer is I don’t know.
“We drove down the cost by half a million for 4700 on value-baed contracts — which is $12 per member per month last year — which is at a time that the gross national product in America and globally is 2.5 to 3.5 percent, while health care over all is up 6 percent and the physician/employee model is up 14.1 percent. This information was in a Wall Street Journal article that came out in September 2018. Dr. Fields, in Houston, has been doing value-based health care for about 15 years, and what they’ve been able to do has driven down the cost of commercial insurance by 15 percent, traditional Medicare by 20 percent and Medicare Advantage plans by 40 percent. That’s impressive.”
“When you take those numbers to employers or different groups or insurance companies, and you can prove that and you can bend the cost curve that much, it’s pretty fascinating. It’s very rare that you see costs go down. Three years in a row, health care has gone up 6 percent, which is double the inflationary rate.”
Value-based health care is divided into two components, Hughes said.
“We’ll talk value first. To have value, you have to prove that your numbers are better; we’re talking with hypertension control, that your patients are taking their medicines and with diabetics, your patients are taking statin, which the current regulations are saying you need to be on,” he said. “Now, try to remember that, and others, off the top of your head as a doctor or nurse. It’s pretty hard. So you have to have a lot of data to indeed prove you’re doing everything right based on the most current accepted standards of all of the specialty organizations, Medicare and what’s been proven to work. (It can’t be) just willy nilly that you did a test and that it was a test of no value. It’s a test that’s actually proven to be successful.
“On the cost side, you’ve got to have transparency so people know what things cost. The second part is to educate them as to what costs are because what’s happening today is that you see companies, even the government to some extent, transferring risk over to the patient. They’re doing that in the form of bigger deductibles, and as they transfer risk, if you’ve got a $5,000 deductible, that first $5,000 is out of your pocket.
“If you can get a test for $4.50 vs. $72 for the same test, where are you going to go?”
Behind the scenes, Hughes said 35 percent of all health care dollars are flowing through value-based contracts, but the general public doesn’t know exactly what this concept is. That is why he said data is key.
“Data is everywhere and the more you have, the more you can manage. (There’s) the old saying, ‘If you can’t measure it, you can’t manage it.’ It’s true of health care too,” he said. “Ultimately, it comes back to the patient, and as we bend the cost curve down, and as we mature and do this more, hopefully we’ll get numbers like they are getting in Houston. (Fields’) places are probably twice the size of this practice, but he doesn’t have the ancillary equipment in house that we do. He does have a lab, but we’ve got a Cat Scan, MRI, some of those advanced things that give us the chance to maybe do some things a little better than he does. It’s kind of a friendly competition between us, I guess you could say.”
Hughes said 2,600 doctors have joined VillageMD, which originated in Chicago in 2014. He also said the board for VillageMD consists of some very well-known names in the medical field, including the man who was the architect for the Affordable Care Act, Dr. Ezekiel Emmanuel.
“They’re thought leaders, and people in Washington listen to them,” he said, noting that one of those is President Donald Trump. “Those leaders want someone sharp to give them advice. Now, you might think that President Trump would never meet with the creator of the Affordable Care Act (which was signed by President Barack Obama after it was passed by a Democratic House). However, you can bet they’re talking about this, particularly when it comes to rising prescription costs.”
The results of the other two value-based contracts will be known soon.
“The results of the first contract are validation. I think that, after doing it for a year here, we know we can actually bend the curve. Can we bend it more?” he asked. “I think so. As you add more services and more staff, you can only expect to get better.”
Hughes said PCMC has six people specifically staffed for value-based health care: two care coordinators, a social worker, a population health manager, data analyst and the state manager for VillageMD. He said their presence is simple.
“Two percent of the population drives about 60 percent of the costs. Ten percent drives about 70 percent, and 20 percent drives about 90. So that means that 20 percent of the most sick people are driving most of it. We’re all over those people,” he said. “We’re following them, tracking them, calling them, we’re even doing house calls now.”