A Philadelphia doctor tapped by the Obama administration to help overhaul the nation’s health system is back for a visit.
Last spring, Dr. Richard Baron left his Philadelphia practice to join the Center for Medicare & Medicaid Innovation in Baltimore. For 22 years before that, he was a neighborhood doctor in Mount Airy.
Early on, Baron recognized the power of electronic medical records to improve care for chronic conditions such as asthma and diabetes. His practice, Greenhouse Internists, was a laboratory of sorts where the state government and the region’s insurance companies tested new ways to pay doctors.
“I think people can get stuck and can feel like the way they are doing it, is the only way they can do it — that’s true in medical practice, it’s true in relationships, it’s true in life,” Baron said.
Baron now has the unwieldy title of “group director for seamless care models,” and his team is experimenting with different approaches.
Sometimes care providers will be given one big check and the leeway to manage a group of Medicaid patients. Other programs will encourage insurance companies and doctors to share information.
“One of the things that is happening in the current fragmented health-care system, and this happened to me all the time when I was in practice — my patients might wind up in an emergency room in another hospital, and I might not know anything about that,” Baron said.
Baron said the health-care system is good at moving new drugs and technologies into health care.
“They get studied, they get proven to work. Then they get put on fee schedules and get paid for,” Baron said. “We don’t have as good a model for researching how delivery-system innovations work, demonstrating that organizing care differently leads to better outcomes at lower cost.”
The dean of the Jefferson School of Population Health, David Nash, invited Baron back to Philadelphia for an update on efforts to redesign how primary care is paid for and delivered.
“We have evidence now that some of these kinds of experiments are working,” Nash said. “We have early research that shows that when you really coordinate care and really pay attention to those details, people do better.”
Nash says it is clear that the government has no plans to spend more money, so public health programs have to find other ways to improve health.
“Lesson two — and this is what health reform is really all about — no outcome, no income,” Nash said. “Unless we can improve the outcome of the work we do, collective incomes will go down.”
If the Medicare and Medicaid center finds better, lower-cost care models, Health Secretary Kathleen Sebelius now has the authority to expand those models to a national level without going to Congress for permission.