Interoperability & HIE
Commonwealth Fund: U.S. Primary Care Docs Struggle With Coordinating Care, Data Sharing
Primary care doctors in the U.S. struggle to coordinate care and communicate with other health and social service providers, according to results from the 2019 Commonwealth Fund International Health Policy Survey, and also published in the journal Health Affairs.
The survey of more than 13,000 primary care physicians in 11 high-income countries revealed that although the U.S. leads in several aspects of health information technology, its physicians still face challenges with coordinating care and exchanging information electronically outside their practice.
The findings showed that primary care doctors in the U.S. trail their counterparts in provider-to-provider communications. While doctors in each of the nations surveyed reported that their practices struggle to coordinate care, the U.S. primary care system falls short in these core areas: communicating with specialists; ED visit notifications; and communication with home care.
What’s more, the research found that U.S. physicians are more likely to offer health information technology to patients, but struggle with interoperability. Amongst the core findings in this area include:
- More than three-quarters (77 percent) of physicians give patients the option of communicating with them via email or a secure website. The use of other technologies—such as video consultations and remote monitoring of patients with chronic conditions—is rare in most countries, but U.S. physicians are among the most likely to use them.
- U.S. physicians face challenges in exchanging information electronically with physicians outside their practice. Only about half of U.S. physicians reported being able to exchange patient clinical summaries, laboratory and diagnostic test results, and patient medication lists with outside physicians. In contrast, most physicians (72 percent to 93 percent) in the Netherlands, New Zealand, Norway, and Sweden reported these abilities.
Additionally, in most countries, physicians find it challenging to coordinate with social service providers that offer housing, meals, or transportation. Roughly four in 10 physicians in the U.S. (40 percent), Australia (38 percent), and Canada (42 percent) frequently coordinate with patients’ social service and community providers. In contrast, 74 percent of physicians in Germany and 65 percent in the U.K. frequently do so. Physicians in France (21 percent) and Sweden (12 percent) are the least likely to say they frequently coordinate with social service and community providers.
Asked about barriers to coordinating patient care with social services, about one-third or more of U.S. physicians said the following are major challenges: no referral system (31 percent in the U.S.; up to 45 percent in France), inadequate staffing (36 percent in the U.S.; up to 56 percent in the U.K), and no follow-up from social service providers (37 percent in the U.S.; up to 61 percent in the U.K.).
“As a physician who practiced general medicine for 35 years, I know the value of primary care and have experienced many of the challenges described in this survey,” David Blumenthal, M.D., Commonwealth Fund president, said in a statement. “While many countries across the globe struggle to deliver all the components of good primary care, many others have developed innovative solutions. We should learn from one another and take steps here in the U.S. to incentivize well-coordinated primary care. Because if it isn’t working, patients won’t get the best care possible.”
Healthcare Leadership
Former Anthem Exec Brad Smith Named CMMI Director
Federal health officials on Jan. 6 announced that Brad Smith, most recently the chief operating officer of Anthem’s diversified business group, will serve as director of the Center for Medicare & Medicaid Innovation (CMMI).
Smith will also serve as a senior advisor for value-based transformation to Health & Human Services (HHS) Secretary Alex Azar, according to a statement released from HHS and CMS. Prior to Anthem, Smith was the co-founder and CEO of Aspire Health, a healthcare company focused on providing home-based palliative care services to patients facing serious illnesses.
Created under the Obama administration, CMMI is charged with piloting, testing and evaluating alternative payment models—such as bundled payment models, for example—with the intent of increasing quality and efficiency, while reducing program expenditures under Medicare, Medicaid and the Children’s Health Insurance Program (CHIP).
“Brad will help HHS and CMS continue and accelerate the value-based transformation work that we have begun under President Trump,” Azar said in a statement. “Paying for outcomes rather than procedures through CMMI models is an important tool for the value-based transformation of healthcare that President Trump has prioritized. Brad has impressive experience with innovative care delivery and paying for value,” he added.
Smith, 37, an entrepreneur from Tennessee, said in an interview with The Tennessean that his core goals will be around figuring out how to “set up the right set of incentives for providers to do the right thing for patients and to empower patients to get better care.”
Last April, HHS announced a set of voluntary value-based payment models for primary care physicians under the label “Primary Cares,” comprised of several voluntary payment options focused on serving patients with complex, chronic conditions and those with serious illness. Smith’s former company, Aspire Health, was part of the coalition that that worked to develop and champion the new models.
In a statement applauding Smith’s nomination, Senate health committee Chairman Lamar Alexander (R-Tenn.) said, “Brad has exactly the right experience to lead a center charged with coming up with innovative ways to lower healthcare costs and improve quality. He has founded a successful healthcare company and knows how state and federal governments work…”
Last July, news broke that previous CMMI Director Adam Boehler would be leaving the department after serving in that role for a little more than a year. Boehler ended up leaving CMMI to head up the recently formed International Development Finance Corporation, an independent agency of the U.S. government that provides financing for private development projects.
