We Will Never Achieve the Quadruple Aim in A Fee-For-Service Healthcare System
Yesterday I wrote about the great resignation in healthcare with special attention to primary care providers. The quadruple aim is a central quality improvement concept in Amercan medicine that has been around for at least 8 years but we seem to be drifting ever further from realizing these goals in patients with cardiovascular and related chronic conditions. Patient outcomes are worsening. Rates of hypertension control are declining and the complications of chronic kidney disease and heart failure are increasing.
The majority of Americans say our system needs major changes or a complete overhaul in keeping with the assessment of the National Academy of Medicine. Wre already spend twice as much as other deleveloped countries as a percentage of gross domestic product. Costs will “only” increase by 6.5% this year compared with 7% last year. Patient experience is definitely not improving and costs continue to outrun wage gains.
To make the negative quality grand slam complete, providers are leaving the healthcare workforce in droves. “One in five physicians say it is likely they will leave their current practice within two years. Meanwhile, about one in three doctors and other health professionals say they intend to reduce work hours in the next 12 months, according to recently published survey research….burnout, workload, fear of infection, anxiety or depression due to COVID-19 and the number of years in practice were associated with intent to reduce work hours or leave.” The great resignation is especially acute in primary care. The National Academy of Medicine called for drastic change 21 years ago and this crisis is the result of leadership that does not serve patients or primary care providers.
Fee-for-service payment is a barrier to progress. We can only achieve the quadruple aim with a value-based payment model that supports it. There has never been a greater need for practical, courageous healthcare leadership. The National Academy of Medicine laid out a plan to finally cross the quality chasm and there are some healthcare leaders working now to build the bridge. Won’t you join other stakeholders to begin the journey ? That is the only way we will achieve the quadruple aim.