Value over Volume: A New Trend in Primary Care

What if going to see your doctor could be a spa-like experience, where you’re ushered into an attractive lobby with comfy couches, a welcoming fireplace, and free coffee—a place where your every health need is attended to, at no additional cost.

It’s called Iora Primary Care, and while you can’t get a manicure there, you can receive premium health care from a caring team, says Dr. Carroll Haymon, Iora’s regional medical director in the state of Washington and head of its office in Seattle’s Central District.

With primary care offices in Seattle, Shoreline, Renton, Federal Way, Tacoma, and Puyallup, Iora accepts patients with traditional Medicare (Part A and Part B) with or without most supplement/Medigap plans, as well as Humana Medicare Advantage plans.

“We see our patients as partners in their health, helping them to succeed and thrive, to have a deep understanding of their health,” says Haymon. “We put a lot of time and energy into that. It’s value-based care as opposed to volume based.”

The traditional primary-care model is fee-for-service, meaning you get a face-to-face visit with a doctor who then charges your insurance for service rendered. Critics claim this is an expensive, inefficient way to handle care, resulting in frustrated doctors and poor patient outcomes.

The value-based model that Iora and some other organizations use is different. Insurance companies pay doctors a monthly sum at a higher rate that, in theory, costs less because patients are healthier.

It seems to be working, Haymon says. “We see people when they’re sick, but also when they’re well so that we can keep them healthier. Iora has a 40 percent decrease in patient hospitalizations, a 20 percent decrease in emergency room visits. And we have high satisfaction scores,” she says. “Iora patients report an average 90 net promoter score—that is, how likely patients are to recommend us —where the industry average for primary care is three.”

Megan Prock McGrath, Iora’s director of public relations and communications, explains that they achieve these results through a coordinated, relational approach. “Our care is built on genuine relationships and our care team works together to treat the whole person. At Iora, each patient gets a team dedicated to their care.”

That team includes a physician or nurse practitioner, team nurse, behavioral health specialist as needed, clinical team manager, and an operations assistant. “Just as important, each patient is paired with a health coach that works with them to determine their health goals,” Prock McGrath adds. “The team spends more time with patients, listens to them, and respects and addresses their questions, concerns, and goals.”

Haymon notes that Iora teams take a much deeper dive into patient conditions than the average 12-minute doctor consultations offered in traditional medicine.

“We’re working to build patient skills,” she says. “For example, take someone with high blood pressure. Often in traditional care, it goes like this: You have high blood pressure, here’s a pill, see you in three months, good luck. But in the value model, we can take the time to make sure that people understand their condition, what the medications are for, what they do, what the side effects might be. And if they have concerns or questions, they can call their health coach.”

Haymon came to Iora from a career in traditional medicine as a family doctor and a teacher. “Although everyone tries their best and works hard, I felt that the problems revolved around the delivery of care,” she notes. “We don’t have a health care system that promotes the right priorities, especially for people as they age. What’s rewarded is volume, not value. That means more tests, labs, imaging, consulting, specialists, more drugs. We have a very expensive health care system, a lot of expensive drugs and care that is often not coordinated; the left-hand doesn’t know what the right hand is doing.”

In 2014, she saw an opportunity for change via Iora. “In the beginning, we just had two doctors and people thought I was out of left field. But we built up our teams that are focused on the whole person, not just a collection of organs.”

Value-based care appears to be making inroads on fee-for-service. “There’s increasing interest in it nationally,” Haymon says, “and programs like ours are gaining traction as they get better outcomes at a lower cost.”

She points out that in Washington state, no organization is doing things quite the way Iora is but there are similar reimbursement strategies available.

One major change agent is the Washington State Health Care Authority (HCA), which buys coverage for more than 2 million people through Medicaid and the Public Employees Benefits Board program. HCA is using its considerable buying power to move away from fee-for-service plans to value-based care. By 2021, HCA plans to move 90 percent of state-financed health care to value-based payments.

In the end, patients are not the only ones who will enjoy the benefits of this kind of care, says Haymon. “I found that in traditional care many doctors are frustrated with the limits put on them. They’re tired and burned out,” she says. “But in this model, doctors are happy. At last, they can give the care they want to offer. This is care they can believe in.”

Connie McDougall is a former news reporter and current freelance writer of nonfiction and personal essays. A lifelong student and proud English major, she has pursued lessons in flying, scuba diving, tai chi, Spanish, meditation, hiking and, most recently, Zumba.