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
Strongwater08_pullquote primary care value proposition and disruptive innovation

The Evolution of Primary Care: Embracing Innovation While Protecting the Core Value

Primary care must leverage disruptive innovations to ensure that patients receive first-access, comprehensive, coordinated, continuous care that is woven into a seamlessly integrated system.

Berns01_pullquote nephrologists dialysis facility joint venture conflicts of interest

Dialysis-Facility Joint-Venture Ownership — Hidden Conflicts of Interest

Despite potential benefits, joint ventures between nephrologists and dialysis companies raise legal and ethical concerns because of participants’ conflicts of interest and lack of transparency.

Fee-for-Service Continues to Account for the Majority of Revenue

New Marketplace Survey: Transitioning Payment Models: Fee-for-Service to Value-Based Care

In a survey of the NEJM Catalyst Insights Council sponsored by Optum, respondents express enthusiasm for value-based care but have conflicting opinions about just how far along that path they should go.

Sample Report Comparing Individual Patient-Reported Outcome Measures with FORCE-TJR National Norms

The Essential Role of Patient-Centered Registries in an Era of Electronic Health Records

Smartly designed patient-centered registries capture longitudinal data to augment EHRs and enhance quality improvement, policy, and research efforts.

Murray02_pullquote surgical care bundled payments accountable care organizations

Surgical Value — Beyond Bundled Payments

The surgeon has a crucial role in defining value for patients in a population — and not just when that patient is in need of the surgeon’s knife.

Comparison Between Traditional and Proposed Health Reimbursement Plan for Primary Care Outcomes Model Across Five Key Domains

Payment Designed for People: Introducing the Primary Care Outcomes Model

A care and payment model that engages primary care physicians in an aligned model built on trust and value could result in better patient care at lower costs.

Figure 1. Differential Changes in Total Medicare Spending for Patients in Accountable Care Organizations (ACOs), According to the Type of ACO, Year of Entry, and Number of Years of Participation.

Medicare Spending after 3 Years of the Medicare Shared Savings Program

After 3 years of the MSSP, participation in shared-savings contracts by physician groups was associated with savings for Medicare that grew over the study period, whereas hospital-integrated ACOs did not produce savings (on average) during the same period.

Reason and Potential Cost Changes for Patients with Treament Recommendation Changes During MD Anderson Cancer Center Multidisciplinary Team Meetings

Great Minds Don’t Always Think Alike

How multidisciplinary team meetings improve cancer care.

Mechanic02_pullquote self-insured employers

Self-Insured Employers — The Payment-Reform Wild Card

Without more private-sector leadership, U.S. health care will remain stuck in a fee-for-service system for the foreseeable future.

Washington State Health Care Authority Center of Excellence joint replacement elements and outcomes of program produces strong patient experience scores

Improving Care by Redesigning Payment

A state-run center of excellence uses benefit design to improve outcomes while controlling cost.

Connect

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

Learn More »

Topics

Value Based Care

190 Articles

The Evolution of Primary Care: Embracing…

Primary care must leverage disruptive innovations to ensure that patients receive first-access, comprehensive, coordinated, continuous…

Dialysis-Facility Joint-Venture Ownership — Hidden Conflicts…

Despite potential benefits, joint ventures between nephrologists and dialysis companies raise legal and ethical concerns…

Dialysis-Facility Joint-Venture Ownership — Hidden Conflicts…

Despite potential benefits, joint ventures between nephrologists and dialysis companies raise legal and ethical concerns…

Insights Council

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

Apply Now