The Tension Between Primary Care Physicians and Specialists

I’ll tell you what I wanted to figure out: How does care improve in SNF (skilled nursing) or assisted living facilities? My starting point in contemplating a possible path toward this goal was advanced primary care. There is so much talk and evidence these days about advanced primary team-based care and how much patients like it, the low-value care it could potentially prevent downstream, and the patient outcomes it can create. But in general, these advanced primary care models are talked about for patients in the community, not really for the intensely vulnerable populations inside facilities. So, where do these worlds collide if they do, in fact, collide?

In this health care podcast, I’m speaking with Grace Terrell, MD. Dr. Terrell is a practicing general internist. She is also chief executive officer of Eventus WholeHealth, which is a company that is focused on medical care for medically vulnerable adults, specifically those who live in skilled nursing facilities, assisted living facilities, or reside at home and cannot make it into clinics or otherwise get care.

Dr. Terrell and her team at Eventus have done some really powerful work bringing this kind of advanced primary care model, whole-person integrated primary care, into long-term care facilities; and she shares some of the promising results of doing so during our conversation. But for more, go to links in the show notes.

One point that Dr. Terrell made, which I found really interesting—maybe not in a good way—is that in an FFS (fee-for-service) world, there is really zero financial incentive beyond consumerism to improve care. Skilled nursing facilities get paid a set of Medicaid/Medicare rates, and that’s it, whether the facility is awesome or it kind of sucks.

In this conversation, we also get caught up on the latest goings-on in the post-acute and assisted living parts of our industry, which, of course, were decimated by COVID pretty much bashing it from all directions. Add to the challenges of 2020 the general truth that SNF and assisted living care for years has been chronically underfunded and highly regulated in ways that aren’t super productive of better care in many cases. Bottom line: There’s a lot of work that needs to be done so that all of us have the best chance of great holistic medical care when we’re older. And we shouldn’t forget the lessons that we’ve learned in the community to make that happen.

You can learn more at eventuswholehealth.com and follow Dr. Terrell on Twitter.

Grace E. Terrell, MD, MMM, is CEO of Eventus WholeHealth, a company focused on integrated value-based behavioral medicine and primary care in the long-term care space. She is a national thought leader in health care innovation and delivery system reform and a serial entrepreneur in population health outcomes driven through patient care model design, clinical and information integration, and value-based payment models. She is the former CEO of Cornerstone Health Care, one of the first medical groups to make the “move to value” by lowering the cost of care and improving its quality for the sickest, most vulnerable patients; the founding CEO of CHESS, a population health management company; and the former CEO of Envision Genomics, a company focused on the integration of precision medicine technology into population health frameworks for patients with rare and undiagnosed diseases. Dr. Terrell currently serves on the US Department of Health and Human Services Physician-Focused Payment Model Technical Advisory Committee and the board of the AMGA (American Medical Group Association), is a founding member of the Oliver Wyman Health Innovation Center, and is the coauthor of Value-Based Healthcare and Payment Models.

04:09 “The industry itself is in a real pickle.” 04:49 What are the fiscal opportunities that a SNF might have in a value-based care model? 09:34 What’s the basic principle that needs to be true to provide the best care possible in a SNF environment? 11:05 How does whole-person care work? 15:51 “It does require integrative care; it does require somebody … to be steering the ship.” 18:53 “This population doesn’t necessarily do well with the typical medications that are prescribed … by a specialist.” 20:49 “Most of us in health care … don’t have the opportunity to build something from the ground up. You have to work in the system that you’re in.” 23:10 “More and more people are thinking about integrative models of care.” 27:50 “Integrated care is very much based on … access to information, access to communication capabilities, the ability to know what the patient wants, … and the skills to actually provide them good care.” 29:27 “Once you get past critical thinking and get into … creative thinking, you’ll find that there’s just a ton of folks out there who want to be with you, who want to create with you.”

You can learn more at eventuswholehealth.com and follow Dr. Terrell on Twitter.

@gracet22 discusses #healthoutcomes of #skillednursing and #assistedliving facilities on our #healthcarepodcast. #healthcare #podcast #digitalhealth

“The industry itself is in a real pickle.” @gracet22 discusses #healthoutcomes of #skillednursing and #assistedliving facilities on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What are the fiscal opportunities that a #SNF might have in a value-based care model? @gracet22 discusses #healthoutcomes of #skillednursing and #assistedliving facilities on our #healthcarepodcast. #healthcare #podcast #digitalhealth

What’s the basic principle that needs to be true to provide the best care possible in a #SNF environment? @gracet22 discusses #healthoutcomes of #skillednursing and #assistedliving facilities on our #healthcarepodcast. #healthcare #podcast #digitalhealth

How does whole-person care work? @gracet22 discusses #healthoutcomes of #skillednursing and #assistedliving facilities on our #healthcarepodcast. #healthcare #podcast #digitalhealth

“It does require integrative care; it does require somebody … to be steering the ship.” @gracet22 discusses #healthoutcomes of #skillednursing and #assistedliving facilities on our #healthcarepodcast. #healthcare #podcast #digitalhealth

“This population doesn’t necessarily do well with the typical medications that are prescribed … by a specialist.” @gracet22 discusses #healthoutcomes of #skillednursing and #assistedliving facilities on our #healthcarepodcast. #healthcare #podcast #digitalhealth

“More and more people are thinking about integrative models of care.” @gracet22 discusses #healthoutcomes of #skillednursing and #assistedliving facilities on our #healthcarepodcast. #healthcare #podcast #digitalhealth

“Once you get past critical thinking and get into … creative thinking, you’ll find that there’s just a ton of folks out there who want to be with you, who want to create with you.” @gracet22 discusses #healthoutcomes of #skillednursing and #assistedliving facilities on our #healthcarepodcast. #healthcare #podcast #digitalhealth