3 Things I Wish I Knew: Dr. James Leoffelholz

Doctor who oversees value-based programs at Boseman Health in Montana says communication and education are important to successful program

Advice Dr. James Loeffelholz, System Director of Clinical Value at Bozeman Health in Bozeman, Mont., would give to his earlier self before participating in value-based care.

Make sure your personal and organization’s fundamental philosophies support your efforts. I’ve come to view fee-for-service reimbursement and the ensuing productivity-based physician compensation as rot at the core of American healthcare incenting wrong behavior in the system and only some of the proper behavior to which I swore a Hippocratic oath. One might view my desire to end fee-for-service reimbursement as quixotic, but as I visit with patients about the CMS models and describe value-based care as being reimbursed based on how WELL we care for patients instead of how MUCH we care for patients, I have yet to hear someone say that sounds like a bad idea.

Ensure value-based care and model participation is done WITH clinical teams and not TO them. If those taking direct care of patients aren’t on board, failure is nearly certain. This means frequent communication and education, and systems should be in place to recognize the care team’s efforts.

Because so much of value-based reimbursement is based on appropriate determination of patient risk, begin early to ensure systems support thorough and accurate documentation of HCCs [Hierarchical Condition Categories], which are frequently nonsensical to begin with – why should a physician need to document every year that a patient has had an amputation? Because the actual determination of a patient’s risk score is based on documentation from years prior, you won’t see results of this effort for some time.

More about Dr. Loeffelholz’s experience:

1. What is your role in the CMS model?
   
   I oversee Bozeman Health’s participation in voluntary value-based programs. I research models, evaluate prospects for success, present models to clinical teams and executive leadership for participation decisions, ensure requirements and deliverables are met, track performance, and facilitate performance improvement. Our CMS model participation includes Comprehensive Primary Care Plus, Primary Care First, Bundled Payments for Care Improvement Advanced, Enhancing Oncology Model, the Medicare Shared Savings Program via our membership in the Sycamore ACO managed by Main Street Health, and voluntary participation in the Transforming Episode Accountability Model.
    
2. How long have you been participating in value-based care? What was your first experience?
   
   Bozeman Health’s participation in value-based care dates back to 2011 when our primary care clinics became the first in Montana to be recognized by NCQA [National Committee for Quality Assurance] as Level III patient-centered medical homes, which we utilized for participation in a voluntary value-based program with BCBS MT [Blue Cross Blue Shield of Montana].
    
3. What was your initial interest or reason for practicing value-based care?
   
   As a primary care physician by training, I recognized early that fee-for-service reimbursement does not properly recognize the full work of primary care. The ongoing continuous nature of managing a primary care patient panel for best outcomes requires effort of a team outside of standard office visits, and Bozeman Health began investing in team-based primary care in 2009.
   
   Value-based reimbursement is a means to recognize this; we expanded to episodic subspecialty care to continue our maturation and take advantage of our inherent high-value status.