Covered California, CalPERS team up to make sure your needs are met at your doctor’s office
Three health care industry heavyweights will work together to improve the quality of the day-to-day care that Californians receive at their doctor’s offices as part of a pilot program they announced Thursday.
The goal, they say, is ensuring that patients can get the care that they need from the doctor’s office responsible for their primary care, said Crystal Eubanks, senior director of care redesign at Purchaser Business Group on Health, so that means the primary care doctor’s practice likely will have to expand their teams to meet patient demands.
The nonprofit PBGH represents about 40 private and public employers that purchases $100 billion annually in health care services, and it has joined with two other colossuses — the California Public Employees’ Retirement System and Covered California — in funding, developing and steering this pilot.
They are not dictating the types of hires that physicians add to their teams, Eubanks said in a telephone interview. Rather, they are setting benchmarks to assess the value and quality of patient-centered care.
PBGH has invested years of research into helping medical teams determine the type of expertise, infrastructure and tools they need to meeting patient needs through a health care improvement program called California Quality Collaborative. Their process relied upon input from purchasers, health plans, providers and patients.
In this new pilot, set to start in January 2022, PBGH will now take benchmarks derived from that work and use them to assess physician practices that serve PBGH groups but also 1.5 million CalPERS members and Covered California’s 1.6 million enrollees.
“Raising the bar on the quality of care delivered not only leads to better outcomes for Californians, it also continues our mission to address the underlying costs of care, and making coverage more affordable to everyone,” said Dr. Alice Chen, Covered California’s chief medical officer, in a prepared news release. “Covered California is committed to going beyond just getting people health care coverage — we want to make sure consumers are getting the quality care they need – and that starts with high performing primary care.”
So, how will you know if the benchmarks are driving change at your primary doctor’s office?
Eubanks cited some examples of things patients will notice. Your doctor’s office will:
▪ Offer all the immunizations your family needs and track to ensure you’ve gotten them on time.
▪ Ensure you’re getting all cancer screenings on schedule.
▪ Regularly perform checks for diabetes and other chronic illnesses and provide a way to monitor whether you’re managing those chronic illnesses.
▪ Meet needs for services such as dermatology or mild or moderate behavioral health conditions.
▪ Offer same-day appointments in a manner that meets patient needs.
Small practices may choose to share the cost and services of a behavioral health worker or a community health worker, Eubanks said, because they may not need a particular team member’s services on a full-time basis.
Down the road, Eubanks said, this effort will provide more transparency into which practices are offering high-value, low cost care that is meeting the needs of their patients.
This story was originally published September 30, 2021 at 11:54 AM.
