How to achieve the Triple Aim plus physician satisfaction

I am responding to the article, “Frustrations of the primary care physician should be a wakeup call.” Having practiced medicine for 25 years as a primary care physician, and accountable primary care physician for the past 10, I understand the demands on PCPs’ time and the pressure to please patients, satisfy documentation/coding requirements, manage care teams, run a practice, and earn a living. However, there are some best practices that can be incorporated to help us physicians get off the fee-for-service hamster wheel and expand our capacity while increasing our satisfaction on our journey into value-based care.

I believe providers should be incentivized to create value for our patient populations. However, we also need the structures, incentives, technology, and workflows to enable us in value-based contracts. This creates a cycle that expands capacity while providing quality care, at reduced cost, for maximum return on health care investment by having all players acting together for population health management. It is because of the economics of gain-sharing in value-based contracts, specifically Medicare Advantage, that we can afford to spend more time with patients — typically 30 minute visits for many seniors — to address potential and emerging issues. When revenue is capitated, we can afford to deliver care through email and video visits.

With the volume of current patients, and given that we are taking on new patients because of the Affordable Care Act, it’s no wonder that patients get frustrated when needs aren’t being met because of resource constraints. Also, when sick, a patient and her family are only concerned about immediate attention and care, which is natural. In these scenarios, patients and providers are frustrated with each other because they’re not working together, and the physician has lost control, autonomy and order. To deal with capacity constraints, involve the whole care team: comprised of the patient, family members, PCP, NPs, PAs, medical assistants and case managers. Provide them with the resources to communicate, such as email, telephonic care, video visits, and patient portals. Data from Kaiser Permanente indicate that as long as the patient thinks the PCP knows what the team is doing, it makes little difference whether the person contacting them is a registered nurse or medical assistant.

Another way to address our frustration is by helping to nurture meaningful, caring relationships with patients. Generally, we enter the field of medicine to provide care in order to keep healthy patients healthy and help sick patients get better. Fostering long-term relationships with patients and families produces a satisfied patient, and it makes me feel like they are my family members: The work is much more meaningful. This is fostered with the evolution of online and smartphone resources that allow PCPs and office staff to maintain virtual contact and information dissemination so that in-person appointments are meaningful, engaging and fulfilling.

By rewarding and encouraging PCPs to engage patients in their health care, the Triple Aim plus one can be achieved: better health outcomes, lower cost, and improved patient plus physician satisfaction.

Tom Doerr is director of innovation research, Lumeris.

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  • doc99

    Medicine ceased being a profession the day I received my first “Dear Provider” letter.

  • NPPCP

    I know you are responding to an article about physicians – but here I go again. I own a private NP practice and a physician is part of my team – I employ them. There is absolutely zero reason why they should be any more satisfied than me. I am referring to primary care. If the whole “team” (that term is a joke all by itself) is satisfied then work on the triple aim or the triple double, or hat trick. You don’t get to be focused on all by yourself because you are a physician anymore. The system will not fall apart without you as a PCP anymore. I’m posting this with the utmost respect to the regular posters here (buzz, southern, ninguem, PCPMD, deaddoc, and all the others). My satisfaction as a Nurse Practitioner who sees 20-30 patients all day long all alone by myself is just as important as yours. Wearin’ me out with all the physician (primary care physician) focus on themselves as “expecters” of sole satisfaction by utilizing “their team”. It’s the 21st century. It doesn’t work that way anymore.

    • SteveCaley

      Satisfaction is not a zero-sum quantifiable commodity, like shoes or ketchup, that needs to be equitably distributed according to Lenin’s formula (to each according to their abilities, etc.) It cannot be collected and distributed. Equalizing the misery is hardly a bright new vision for the future.
      For sheer delicious, brain-rattling euphoria, I recommend liberal use of full mu-receptor agonists. Once we come up with a true Soma (not carisodoprol), the American Medical Workplace can transition to Nirvana. No reusing needles, though.

  • Ed

    “To deal with capacity constraints, involve the whole care team: comprised of the patient, family members, PCP, NPs, PAs, medical assistants and case managers.”

    As the name clearly implies, my primary care physician is my healthcare provider; a team of exactly two. Any involvement of ancillary staff will be based upon his professional recommendation and my informed consent.

    • SteveCaley

      But committees protect us from the discomfort of guilt. If the Committee decides that Grandma won’t get dialysis, then the committee bears the responsibility.
      Now that we have grasped the moral Brass Ring, the power to forgive ourselves absolutely, with a religious intensity of mercy, we each have a silent, brooding private consciousness. And, of course, we know WE are the moral ones – WE would never send Grandma to her grave, if it were just OUR decision. But rules must be followed, and boxcars loaded, etc. We dare not expose our consciousness to that brutal world outside – it would be blasted with icy winds. Best to keep it in the greenhouse, safe. Shhhhh.

  • SteveCaley

    Why do we use jargon such as “Triple Aim?” Why does it sound SO much like Maoist propaganda for the Chinese peasants?
    “It is IHI’s belief that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim”:
    -Improving the patient experience of care (including quality and satisfaction);
    -Improving the health of populations; and
    -Reducing the per capita cost of health care.

    Is there anything about this word-salad of concepts that is new? That conveys some stimulus to thought? That indicates some conceptual connection between the parts that leads to something beyond their parts?
    Without that, it is a sterile restatement of a vapid but memorizable meme, issued by the Government, to encourage obedience to sub-directive.
    I dunno. Sounds like propaganda to me….
    “Suppress the Five Running Pig-Dogs of Capitalist Thought!” Yah, sounds like…Got any freshies from North Korea?

  • buzzkillerjsmith

    Exactly.

    “Data from Bernie Madoff indicated that as long as the rubes thought Bernie was acting in their best interest, it made little difference whether he was actually doing so or was in fact robbing them blind.”

  • guest

    Great, more verbiage about how practicing clinicians can best practice medicine in a completely screwed-up healthcare system–from someone who is not actually practicing medicine in that system.

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