About one in four U.S. physicians are not prepared to effectively manage and coordinate the care of patients who have multiple chronic conditions, a troubling finding in a new Commonwealth Fund study that comes as insurers move to value-based care models.
The ability of doctors to manage chronic conditions like diabetes, high blood pressure and asthma is important to improving quality and slowing the increase in healthcare costs. Managing chronic conditions is also a key aspect of how doctors increasingly are being paid by the government under the Affordable Care Act and by employers and commercial insurers generally.
“We are not doing well coordinating care of the sickest and most costly patients,” Dr. David Blumenthal, president of The Commonwealth Fund said in an interview. “We probably have the worst primary care system in the world.”
Researchers interviewed primary care doctors in 10 countries as part of the data used by the 2015 Commonwealth Fund International Health Policy Survey of primary care physicians. The full nine-page report is published in the December issue of the journal Health Affairs.
The U.S. stands out among the 10 developed western countries in that it has the youngest population but spends the “highest incidence of chronic disease and spends 50% to 150% more on healthcare per capita,” researchers wrote. The other countries examined were Australia, Canada, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the United Kingdom.
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The timing of the research comes at a time the Medicare insurance program for elderly Americans and commercial insurers are moving away from fee-for-service payments to doctors that lead to higher volumes of service and unnecessary tests and procedures. Instead, the government and health plans like
The Commonwealth Fund survey said U.S. physicians stood out as “being among the least prepared to manage conditions associated with aging outside of hospital or nursing home settings.”
“We have a problem that has been a long time in the making,” Blumenthal said in an interview.
Blumenthal said more incentives need to be created for primary care health professionals on the “front lines” and the Affordable Care Act and commercial payers have launched various efforts such as primary care medical homes and accountable care organizations (ACOs) to address these issues. “It’s helping but it will need to be applied consistently over a long period of time,” Blumenthal said.
