New Marketplace
Clip
Change the Model → Change the Curriculum (02:23)

If we’re going to change the health care payment model, how much do we need to change medical school curricula and how we train physicians?

Michael McWilliams, an internist at Brigham and Women’s Hospital, answers this question in relation to the utility of measures in a management context. “Do we really need measures to change physician behavior?” he asks. McWilliams, who supervises medical residents, says that his students aren’t measured on how many MRIs for back pain they do, for example, and then told they’re doing too many. Instead, they’re taught not to do a test unless it will change their management. “Be thoughtful, and then let’s work out how we apply this to every clinical context,” he says. Students complete their training with this principle, which later affects various Choosing Wisely–like measures.

But that’s where the training ends, other than studying for one’s boards. “It’s kind of crazy that we don’t retrain clinicians and we don’t really manage them either,” McWilliams says.

It’s easy to say, “We should add this to the curriculum,” adds Griffin Myers, Co-founder and Chief Medical Officer for primary care provider Oak Street Health. “So the first question is, what are we going to take away to be able to add this stuff in?”

“I don’t think that people graduating today finish unequipped to take care of patients,” Myers says. But there is extra to learn. He describes Oak Street’s approach to addressing new knowledge. “There’s a bunch of stuff here that is contextual, important to your practice. Do you know this stuff? You don’t? Okay, then we’re going to invest in teaching it.”

From the NEJM Catalyst event Navigating Payment Reform for Providers, Payers, and Pharma, held at Harvard Business School, November 2, 2017.

More From New Marketplace
Effect of Value-Based Payment Programs on Providers That Serve the Poor

Financial Incentives and Vulnerable Populations — Will Alternative Payment Models Help or Hurt?

Understanding APMs’ potential consequences for vulnerable populations is critical if we wish to maximize benefits and reduce harms.

Example 4-Quadrant Analysis and Price Setting for a Single-Procedure Bundle - Lessons Learned from DRG Implementation

Making Bundled Payments Work: Leveraging the CMS DRG Experience

Given its clout and experience, CMS is uniquely positioned to lead the U.S. health system toward high-value care. Bundled pricing based on real costs, leveraging lessons from DRG implementation, would establish the right types of provider incentives.

Kocher03_pullquote risk-based primary care provider

Opportunities for Risk-Taking Primary Care Providers

Embracing two-sided risk while adopting workflow redesign and reviewing benchmarks is leading to improved clinical and financial outcomes.

The Unrealized Potential of EMRs: Interoperability and the Opportunity for Disruption

NEJM Catalyst hosted clinical and business leaders, along with the originator of “disruptive innovation,” to consider the user frustration, high cost, and lack of interoperability of electronic medical records.

Steven Seltzer Andrew Menard Clayton Christensen Edward Prewitt Electronic Medical Records Roundtable Head Shots

The Unrealized Potential of EMRs: Why They Fall Short and the Unexpected Source of a Solution

NEJM Catalyst hosted clinical and business leaders, along with the originator of “disruptive innovation,” to consider the user frustration, high cost, and lack of interoperability of electronic medical records.

Robert Gavin head shot

Amazon and CVS: Short-Lived Unicorns in Health Care, or Healers of the “Tapeworm”?

Will Amazon–Berkshire Hathaway–JP Morgan and CVS-Aetna change the health care game? To one health care employer purchaser, these announcements feel a lot like Groundhog Day.

Fiona Scott Morton head shot

We Can’t Spend All Our Money on Health Care

We have to think about how much we want to spend on health according to how much it’s worth to us at the margin.

Simplified Chain of Production for Primary Care Services Generating Retail Prescriptions. Solid arrows indicate contractual relationships or ownership, and the dashed arrow indicates referral for prescription.

Does CVS–Aetna Spell the End of Business as Usual?

What might one of the largest mergers in history mean for the health care delivery system?

Lack of Incentive Is Top Barrier to Implementing Value-Based Payment

Survey Snapshot: Payer-Provider Alignment Is Difficult Even for Integrated Organizations

NEJM Catalyst Insights Council members say stronger incentives and better use of analytics could improve alignment.

Kaplan04_pullquote Time to Sink Two Canoe Payment Models Argument

Time to Sink the Two-Canoe Argument

Although the transition from fee-for-service to quality-based payment can leave physicians feeling trapped “with a foot in two canoes” while straddling the two payment methods, there are compelling ethical, professional, and business reasons against rationalizing continued support of fee-for-service medicine.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

The Adverse Impact of the Physician-Hero

In a value-based world, the sickest patients need the benefit of a comprehensive team to…

Financial Incentives and Vulnerable Populations —…

Understanding APMs’ potential consequences for vulnerable populations is critical if we wish to maximize benefits…

Change the Model → Change the…

If we’re going to change the health care payment model, do we need to change…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now