As Administrator for the East Hawaii Independent Physicians Association (IPA), Susan Mochizuki is intimately familiar with the challenges rural communities face in moving from volume to value-based care models, educating themselves about the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and implementing programs and processes to respond to all of it. One of the giant steps they have taken on this front is pursuing a Comprehensive Primary Care Plus (CPC+) model.
“We have a total of 68 physician members, 58 are in primary care. Many solo practitioners. Only two or three member offices have more than one provider,” explains Susan. “Many have a receptionist, maybe a medical assistant and possibly a nurse. That’s it.” She goes on to explain that these providers often employ and care for family members, friends and neighbors. “So they are very, very passionate about providing quality care.”
The providers Susan works with often work long hours for a relatively modest income and face challenges accessing resources and support. “They do lack a lot of the tools needed to take advantage of value-based payment systems. Some of them don’t use electronic health records (EHR) yet,” says Susan. “Some are still on paper charts. They enter information the old fashioned manual way.”
Susan and her organization have been working to get all providers on the same EHR so they can share information more easily. It is one of the many workflow improvements they have been working toward over the last few years as they began to explore value-based care and payment models. “We’ve been working with HMSA, the local Blue Cross Blue Shield affiliate, on a new value-based payment model. Physicians have been getting their feet wet with learning how to deal with global capitated payments as well as enhanced pay for quality methods. We have also been involved in patient-centered medical home efforts and have received support from local health plans.”
During the process, they have worked with Harold Miller, President and CEO of the Center for Healthcare Quality and Payment Reform, who encouraged them to apply for a CPC+ grant from the Centers for Medicare and Medicaid Services (CMS).
“CPC+ is a way for our small community to put in place the workflows and processes to provide good quality care to our patients,” says Susan. “We are hoping it will enable us to provide care coordination and management which is so desperately needed. If our providers learned about all of the things and actually implemented measures that Medicare is requiring under CPC+, this would represent very high quality, value-based care.
The effort often calls for walking a fine line while trying to negotiate with multiple partners and stakeholders. For instance, HMSA represents the majority of lives in the region and wants to partner with the IPA. However, they’ve also received an attractive proposal from Caravan Health out of Oregon.
“We’re trying to decide where we should get that support to have the right data and information warehouse, how we can provide training for care coordinators, care managers and the practices and what we can do to improve the workflow.”
In the meantime, the IPA has held a number of workshops aimed at educating and empowering providers to participate. “We bring the provider as well as the staff to the meeting, allow them to ask questions and we actually go into their offices and look at their workflow and try to make suggestions.”
Susan Mochizuki is confident the group will continue to coalesce and grow stronger together. Five years from now, she sees a bright future for health and healthcare in East Hawaii. “Through CPC+ if providers are able to take advantage of all the resources and tools that it offers and learn what they need to do to take better care of their patients overall I think we could see the health of our residents improving. I also envision our providers having a better quality of life because if they improve their workflow, and use team-based care protocols, they will not have to be up at night until 1:00 in the morning charting and running around like chickens with their heads cut off and still take good care of their patients. So I’m excited about that possibility.”