A gastroenterologist and liver specialist, Dr. Cassidy also highlighted the idea of team-based care and said that cardiologists have been leaders in this practice model.
Dr. Barbe also talked about how Medicare can enhance team-based care—which, he said, is a model that the AMA supports—and help address workforce issues such as the physician shortage.
He also spoke in favor of shared decision-making with patients, noting that medicine has been in a 30-year process shifting to this partnership model of care and away from a paternal relationship where physicians “held all the knowledge” and patients faithfully followed instructions.
“We know now that this is the best model,” Dr. Barbe said, noting that superior outcomes come from shared decision-making and that evidence from the Mayo Clinic and the Dartmouth-Hitchcock Center for Shared Decision Making supports this.
Shaheen, the New Hampshire Democrat, said she became interested in shared medical decision-making because of the Dartmouth Center, which is in her state. She called shared decision-making a “no-brainer from a policy perspective” because physicians and patients are happier—and because patients who take part in this more collaborative model tend to choose less invasive, less costly treatment options.
Dr. Barbe added, however, that more information is needed for shared decision-making to work better.
“Transparency, I think, is the key,” he said. “Physicians need to partner with patients to navigate a very complex system.”
As a family physician, Dr. Barbe explained how this navigation is impeded by a lack of knowledge about the specialists in a patient’s insurance network and how much the care those specialists provide will cost.
Shaheen said New Hampshire has been a leader in the trend toward transparency by posting provider cost and quality data on the internet.
Enough of “Groundhog Day”
There was also discussion about co-creating a custom care plan that reflected patient values and goals as well as payment based on customized patient-specific quality measures.
By this time, Dr. Cassidy had left the event, and Shaheen lamented how the Congressional focus on ACA repeal has prevented these sorts of ideas from being explored at a national policy level.
“We can never get to that discussion until we get past this ‘Groundhog Day’ experience,” she said, referencing the movie in which actor Bill Murray’s character lives the same day over and over again.
Shaheen also lamented how a bipartisan effort led by Sens. Lamar Alexander, R-Tenn., and Patty Murray, D-Wash., to stabilize the personal health insurance marketplace was “derailed” by the latest repeal-and-replace effort. After it was announced that the Graham-Cassidy measure would not be voted on, Dr. Barbe released a statement expressing hope that bipartisan effort could be revived.
“While we are relieved that the Senate did not adopt legislation that would have harmed patients and critical safety net programs, the status quo is not acceptable,” he said. “We urge Congress to renew a bipartisan effort to address shortcomings in the Affordable Care Act. In the short term, that means stabilizing the individual marketplace to achieve the goal of providing access to quality, affordable health coverage for more Americans."