Letters: Maybe dropping out of ACOs is a good thing for patients

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, Letters: Maybe dropping out of ACOs is a good thing for patients

Circa 2018, Humana mentioned it discovered that when completely different events used phrases resembling value-based care, they didn’t imply the identical factor. They convened a panel of consultants to develop consensus definitions for the phrases value-based cost, value-based care and inhabitants well being. The skilled panel was unable to reach at a consensus definition for value-based care or inhabitants well being.

In his current editorial “Worth-based care now in danger,” Merrill Goozner assumes that the CMS-sponsored ACO is an “experiment in value-based care.” However it’s unclear what definition he’s utilizing for “value-based care.” Since there isn’t a requirement for sufferers to make use of in-network suppliers, it’s not possible to manage optimum care supply or outcomes, that are hallmarks of all definitions of value-based supply programs.

Perhaps suppliers wish to divert their time from this failed authorities experiment and put extra time into direct affected person care. Now that’s value-based care when you ask me.

Nathan Kaufman
Managing director
Kaufman Strategic Advisors
San Diego


The article “Ladies primary-care docs spend extra time with sufferers, generate much less income” is an unlucky rear-facing view of major care. As an administrator of primary-care clinics in Los Angeles, this provides me hope that ladies medical doctors in major care are, maybe unknowingly, getting ready themselves to be extra profitable than their male counterparts.

The shift in major care that focuses on team-based and value-based care of populations lends itself to rising the worth of primary-care visits, incorporating social determinants of well being, well being schooling, conduct modification and different types of life-stabilization methods. In California, there’s a robust penetration of capitated HMO plans within the market that reward primary-care practices for affected person wellness, decrease utilization of high-cost providers, and higher administration of well being upkeep. Many primary-care practices are thriving on this mannequin.

The first-care transformation is occurring somewhere else just like the College of Utah’s Care by Design mannequin and the College of Colorado’s APEX mannequin as mentioned in an article titled “A team-based care mannequin that improves job satisfaction” within the March-April 2018 difficulty of the American Academy of Household Physicians’ FPM journal. In these and different related fashions, slightly than the sufferers solely searching for care when they’re sick or injured, practices have gotten a spot the place sufferers can talk extra repeatedly with their primary-care group, and essentially the most acceptable individual on the primary-care group (usually not the doctor) is made accountable for responding to the affected person’s concern or query.

The target is for a primary-care observe to have a more healthy affected person inhabitants total so the primary-care doctor will be capable of dedicate extra time to these sufferers who actually need the time with the doctor, for which this text signifies girls are better-suited.

For my part, essentially the most unlucky actuality of the U.S. healthcare system is the fee-for-service mannequin that values income technology (quantity) over well being outcomes (worth). Because the shift to worth and prioritization of effectively care over sick care advances, maybe girls physicians are main the way in which.

Chad Vargas
Chief working officer
QueensCare Well being Facilities
Los Angeles


Relating to the Sept. 21 editorial “Limitless mendacity impacts us all,” as a longtime subscriber and reader, it has been apparent on which facet of the political fence Merrill Goozner has been, however his opinion on this column doesn’t heed the recommendation of former first woman Michelle Obama and goes actually low. I don’t recall him opining about “when you like your physician, you’ll be capable of hold your physician; when you like your well being plan, you’ll be capable of hold your well being plan” and so many others in the identical language.

It’s unhealthy to specific this diploma of loathing for any president.

Dr. Bhagwan Satiani
Columbus, Ohio


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