A recent American College of Radiology® (ACR®) Patient- and Family-Centered Care Commission - Population Health Management (PHM) Committee webinar explained how radiologists can leverage payment models to achieve PHM success. Although PHM is historically centered on primary care, the webinar was the latest in an educational series aimed at conveying the central role that radiology can play in population health management.
Presenters Syed Zaidi, MD, MBA, and Ryan Lee, MD, MBA, Co-Chairs of the PFCC PHM Committee, and John Lohnes Jr., MD, DABR, FACR, shared experiences with payment models and PHM. The doctors broke the PHM continuum down into three major areas: surveillance/prevention, acute care and chronic disease management. Each area, while distinct, builds off of one another in several important ways, particularly with respect to distinct patient populations.
- The surveillance/prevention area of PHM is composed of various types of screening, from mammography screening to CT colonography screening to lung cancer screening, along with using artificial intelligence tools to monitor patients’ health status.
- Acute care, which involves assimilating facets of Imaging 3.0, like direct patient engagement into everyday practice, utilizing Choosing Wisely guidelines and clinical decision support to enhance imaging appropriateness, integrating best practice recommendations into every aspect of care, and IP care coordination.
- Chronic disease management covers aspects of the care pathway such as follow-up programs, oncology intervention and findings which predispose patients to chronic disease such as fatty liver and metabolic syndrome.
Dr. Lee provided a 30,000-foot view of PHM infrastructure, including a history of the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). He delved into why radiology is often perceived as being peripheral to PHM, before charting a path forward for radiology to position itself at the forefront of population health. Of particular importance to radiology are the opportunities for radiologists to collaborate with their health systems and payers to achieve PHM goals.
Dr. Lohnes provided a real-world example of how APMs can help drive PHM adoption. He discussed how his Kansas group realized shared savings by leading a physician-owned accountable care organization. Currently, his group is working on plan design for a physician-owned PPO with its own insurance product. Lohnes shared that in this model, radiologists achieve a risk-sharing carve out for outpatient radiology in partnership with other physician groups.
The presenters offered that PHM is a concept whose time has come, particularly in light of the Covid pandemic. For many, it is clear that fee-for-service is an inadequate payment scheme as the predominant source of revenue. It is also a common view that radiology quality measures haven’t gone far enough in recognizing radiology’s value. The healthcare landscape is experiencing a digital transformation and moving toward value-based payments in a population health management framework. Radiologists can position themselves to succeed in this new paradigm by learning more about tools for risk stratification, and benchmarking and triaging patients in order to become partners with PCPs, health systems and payers in risk-sharing arrangements.
To learn more about PFCC PHM efforts, watch the PHM webinar series.