As a practicing physician, former CEO of a multi-specialty practice, CEO of Envision Genomics, and a member of the Physician-Focused Payment Model Technical Advisory Committee (PTAC)
Grace Terrell has rare, multi-layered insight into what is driving the high cost of healthcare and what efforts are underway every day in communities across the country to make it more affordable.
At Cornerstone, the practice where Dr. Terrell sees patients, the group redesigned the care system so as to be centered around the patient’s goals and desires, and then restructured the payment system to support that approach. “It’s usually not about expensive technology. It’s usually about integrating mental health, physical health, nuitrition and integrated approaches that involve the community as well as local resources at the level of the hospital with the providers. Once you do that you can get some really remarkable results that have lower cost and much higher quality.”
Dr. Terell can speak from experience about strong pushback other stakeholders, like hospitals and insurance plans, may have to such changes. However, she sees such constructive conflict as a necessary part of making healthcare more affordable. She also advocates for what she calls “shame-based learning” – similar to what drove Americans to stop smoking in droves. “We know what we need to do to make it affordable for all and accessible for all and it should sort of be like the conversation we had about smoking in the past. It became an embarrassmemt to smoke. And pretty soon the whole national conversation around that changed.” Dr. Terrell says all stakeholdrers play a role in the current crisis and all should hold each other accountable to doing their part to address it: providers ought to be ashamed for not taking the lead on models of care that are much more patient-centric; hospitals ought to be ashamed for focusing on volume and their own financial bottom lines; payers ought to be ashamed for not working with those providers who are not focused on providing different models of care; communities ought to be ashamed that they’re not working on this in relationship to others; payers and employers should be ashamed they are not working with providers.
“If we were all embarrassed and ashamed and focused on doing what’s right we could probably solve this quite frankly,” says Dr. Terell.
Dr. Terrell highlighted efforts around the country that are bringing down costs:
- Providers are piloting new payment models
- Practices and communities are working with different patient populations to and provide services in different ways – for example, embedding behavioral medicine and pharmacy into care for the frail elderly
- Provider and community groups are proposing new care and payment models under MACRA for geriatrics, gastroenterology, cardiology, and pulmonology and many others
- Care givers are testing the use of genomic approaches to diagnose diseases early, predict which medications, tests and services would be most effective – or likely not effective – and have helped cust costs by hundreds of thousands of dollars in some cases
“There’s already a lot going on out there right now that we can and should build on. We can do this is we approach it together.”