March 6, 2017

Tom Sullivan, M.D.

Herding Cats and Changing Physician Behavior

The idiom “herding cats” typically refers to the impossible task of organizing a class of entities that are uncontrollable or chaotic. As a physician, I can attest first-hand that managing doctors and changing physician behavior is quite a bit like herding cats.

Contrary to popular belief, it is actually possible to herd cats. All it really takes is to move the cats’ food. Physician behavior can also be changed – not by moving their food, but by changing the way that they are compensated. That’s essentially what is happening today as the industry transitions from traditional fee-for-service compensation to quality-based models. As the “food” moves, so does the focus of providers, who are now looking for ways to improve the overall health of patient populations, rather than simply seeking opportunities to treat more patients each day.

Keep in mind that the concept of population health has been around for many years. One of the primary reasons that it’s become a hot healthcare topic is because of the shift from piecemeal, episodic care reimbursements (fee-for-service) to value-based purchasing and pay-for-performance models. The old model ignored the population of patients who neither had the will nor ability to engage in their own care and never visited a doctor’s office, but would instead drive up the cost of healthcare by using the ER as their primary care provider. In order to bend the cost curve, hospitals and physicians are now incented to keep a panel of patients healthy, rather than just delivering care to one patient at a time.

These new incentives are beginning to change provider behavior, but behavior modifications and a shift in focus will be easier once all care team members are equipped with the right technology. More specifically, patients, doctors, pharmacists, and other care team members will benefit from effective, proven solutions that support collaboration throughout the care process and help keep patients healthy.

It’s important that these solutions are more user-friendly and mobile-enabled if one expects broad adoption by all healthcare stakeholders. The reality is that patients and other care team members are not always sitting in front of their computers. Doctors, whether they are in the office or at home with their families, need access to technologies such as secure messaging via their phones, tablets or other mobile devices to communicate with other care team members. To enhance patient outcomes and drive cost-effective care, physicians also need the ability to e-prescribe on mobile devices, verify drug copayments or medication deductible amounts, and advise patients of drug coupons or discount programs.

By leveraging the latest innovations, care team members can obtain patient medication histories, resulting in a streamlined medication reconciliation process and improved patient safety. Additionally, to drive better population health, care team members must have ready access to patient medication adherence information. Clinicians can then verify if patients are complying with medication routines and extend support to patients who are not adhering to recommended therapies.

With the right incentives and technology, physicians will continue to shift their focus away from episodic care and towards the delivery of care that improves health across populations. Now that’s a motivation to herd cats – I mean physicians – towards value-based care.

About Tom Sullivan, M.D.

Thomas E. Sullivan, M.D is a board-certified specialist in cardiology and internal medicine with over 40 years of clinical practice. He currently works for DrFirst and sees patients part-time in Massachusetts. His expertise in the application of information technology to health care has helped to create an international standard (ASTM) for the exchange of medical record information called the Continuity of Care Record (CCR). With AMA, he was founding chair of their e-Medicine Advisory Committee, worked with the Physician Consortium for Performance Improvement, represented the AMA and helped create the Physician EHR Coalition and is past chair of the AMA Council on Medical Service.