034 - Value-Based Care: The Programs, the Problems and Why Physicians Must Lead

My guest is Dr. Roger Fowler, Vice President, and Chief Medical Director of Quality, Performance and Innovation with CHRISTUS Health in Irving, Texas.<br />As an expert in population health, quality, and healthcare reform, Dr. Fowler offers a rich perspective on the historical events that underpin our current state of U.S. healthcare. His belief is that we must move away from payment systems that reward the quantity of procedures performed, and move toward those programs that reward excellent outcomes for patients and the community.<br />Dr. Fowler describes how quality measures themselves have their origins in the way insurance companies ranked desirable vs. undesirable physicians based on each physician’s claims data. It was all about costs. The use of the term Medical Loss Ratio (MLR) is an important reminder of the insurance industry’s perspective about medicine vs. the perspective we as physicians have. MLR means that the resources spent on providing medical care for patients is the Loss referred to in this acronym. A family medicine physician for 40 years, Dr. Fowler says when he first heard medical care referred to as a loss it was like fingernails on a blackboard for him.<br />Dr. Fowler has compelling stories of how the healthcare system goes haywire. He talks about the unintended consequences of early “hospitalization insurance” and EMTALA regulations and he laments the various ways unscrupulous characters cash in on patients’ vulnerabilities. <br />His expertise and patience almost meet their match with my ignorance about Medicare programs. He labors to help me understand some of the key points of Medicare Advantage, Traditional Medicare, ACOs, Shared Savings programs, and more. After we finished our conversation, I requested a CME certificate.<br />As a patient advocate and expert on population health and quality, he is passionate about getting to a reasonable level of spending on primary care (currently only 5-6% of U.S. healthcare spending is on primary care). He believes doubling the dollars spent