Making health care history: A Q&A with Dr. Robert Fields about the new Mission Health Partners network

The way we experience health care is changing. And regardless of your politics, not many would argue that there is room for improvement. Mission Health, in conjunction with MAHEC and independent physicians, is responding to those changes with a new, integrative model of care called Mission Health Partners. Xpress spoke with Dr. Robert Fields, quality director of Mission Medical Associates, to find out more about how Mission Health Partners will change patient care, payment structures and, ultimately, the way people experience health care.

Mountain Xpress: How is this integrated network model a response to the changing landscape of health care in this country? In what ways can we look to this new system of care as a model for the future?

Robert Fields: It is a direct response to two major trends: increasing health care costs and poor outcomes for the dollars spent. Traditional care is based on a structure where providers are reimbursed for a visit or a procedure but not for the other aspects of providing medical care for patients such as coordination of care and education. Additionally, from a patient’s perspective, there was no clear way of assessing value in medicine. We believe that by working together we can provide more efficient and cost-effective care that demonstrates better outcomes. By demonstrating that value to payers, we create a business model to support what has been missing from our delivery systems. This would include shared technology, shared data, care management, team-based care and all of those other aspects of managing populations that are difficult to implement now. This coordination takes time and money and is minimally incentivized now.

Additionally, traditional models focus almost exclusively on the patients in the office. We must work together to manage the health of our community and engaging the patients not in the office. We need to find ways of managing chronic conditions before those patients go to the hospital in a more complicated, emergent state.

It is well-known in the world of population health that the things that greatly determine a patient’s outcomes have less to do with science and medicine and more about mental health, socioeconomics and other social determinants of health. The unfortunate part is that our nation’s health system does little to support work in those areas. With this new model of care, if a particular intervention has been shown to improve outcomes and reduce hospitalizations, we are able to band together and implement the intervention even if it is not a medication, doctor visit or other currently reimbursed service. The outcome and efficiency alone is the payoff for the system.

What does the shift from provider-centric care to patient-centered care mean to you, and how does that shift actually come into play at Mission Health Partners?

Everything from how we order tests to how we schedule visits with a physician is largely based on a model of care that has not changed in almost a century. It is mostly based on a provider’s needs as well as current reimbursement models. There is a constant compromise between what is most efficient or best for patients with the current business model of health care. We can’t escape it. All of our health care institutions have to support themselves to be sustainable, but if the system is financially supported, at least in part, by outcomes and value, then we can structure our models to fully support efficiency, patient engagement and better outcomes.

One concrete example is this: The normal way a patient interacts with a specialist is that a primary care physician sees a patient and determines he or she needs the advice or expertise of a specialist and refers the patient. The patient can wait weeks or even months to see the specialist and then may wait weeks or months again to have a procedure or other necessary care. This is largely based on how we get reimbursed. In order for a specialist to get paid (and of course meet their own business demands of staff, space, etc.), they must receive the referral and see the patient in the office. What if we could get to the same outcome with a phone call between the primary care physician and the specialist? Or a video telehealth visit? The patient can get the same care in a more convenient and often faster environment, and the greater efficiency provides the business model for both providers to work together in this way.

The new models of care also depend on data and quality. It is often difficult for providers to know if they are truly providing quality care. Most providers feel that they are doing “the best they can” and often only receive ad hoc feedback from individual patients. In order to be successful in the new models of care, we must collect and share data regarding our outcomes to identify gaps to know where resources need to be distributed. The network holds high standards for its providers in order to get to the desired outcomes, and we can only measure this objectively with the use of data and shared technology. Additionally, data sharing allows for greater efficiency by reducing repeat testing and more efficient office care — not having to dig for the information the provider needs.

Why is it important for physicians to collaborate in this way? Can you give an example of how this collaboration works at Mission Health Partners?

Collaborating in this way is clearly the path for the best patient experience and the best outcomes. Fragmented care is costly and is frustrating for both patients and providers. One way in which we can collaborate is with transitions of care. If the hospital identifies a patient at discharge who needs a primary care appointment, we will provide the infrastructure for effective communication and coordination between the hospital and the physician’s office so that the patient has that appointment when they need it and that the provider has all the lab work, tests and medication lists they need to manage the patient.

Additionally, if we identify barriers to care that normally would lead to a readmission — often financial barriers that lead to avoiding needed tests or medications — the hospital care manager can work with the patient to  overcome those and will coordinate with the outpatient care manager to follow up. This “warm handoff” from one element of the health system to another ensures that patients are not lost to follow-up and that their conditions do not spiral out of control.

Is there anything else you would like to add? 

The fact that all of these physicians, independent and employed, have been able to form the network and begin to build this infrastructure in less than one year is a testament to the outstanding medical community we have in Western North Carolina. Everyone inherently wants to do the right thing for patients and so the pieces were able to fit rather quickly. I feel very lucky to be a part of this community, and WNC will be well-served by a locally formed network of local physicians, hospitals, nurses, pharmacists and others all working together to get the best outcomes no matter what the logo says outside of their door. It is a historic time for health care in WNC.