VSSL Voices: Working on Primary Care Investment in Washington State

In this installment of our “VSSL Voices” series, we heard from Dr. Jonathan Staloff, a family medicine resident at the University of Washington and current VSSL Fellow.

VSSL Voices: You recently joined the Washington Academy of Family Physicians’ “Primary Care Investment Task Force. What interested you in joining the Task Force?

Jonathan Staloff: I first learned about the Primary Care Investment Task Force when receiving an alert message from the Washington Academy of Family Physicians (WAFP) regarding the Washington State Health Care Authority’s (HCA) Primary Care Transformation Model.

The HCA is trying to develop an alternative payment model (APM) that financially rewards primary care providers appropriately for the contributions we make to population health, while also re-orienting the way we pay for healthcare away from traditional fee-for-service. The WAFP and its Primary Care Investment Task Force were seeking feedback from its members on how to shape this new payment model.

I was so encouraged to see that the HCA is trying to move in this direction, and was struck by how the details of the model itself were still in development. I’m especially passionate about envisioning a healthcare system with population health focused primary care at its center, and when I learned that the WAFP had a task force specifically dedicated to primary care investment, and that this task force was hoping to engage with the HCA in shaping this new model, I knew I wanted to get involved.

"The mentorship I’ve received at VSSL has been essential to my continued interest in studying primary care alternative payment models, and in helping me cultivate a skill set that I hope will be useful to the Task Force."

VV: What things have you experienced in your training thus far that have either underscored or further developed your interests in health systems and/or care delivery work?

JS: I remember in medical school a CEO of a major hospital system came to speak to a small group of students interested in healthcare systems. He mentioned that his hospital system recently decided to invest in primary care practices and focus on population health. I asked the speaker how much his institution paid attention to what happened to the health of its patients after they were discharged from the hospital before the ACA was enacted. He truthfully said hardly at all. I asked him how much his institution paid attention to the health of its patients outside the hospital now, and he said that because of various payment reforms, it was always on his mind. He said that ongoing changes in how we pay for healthcare are a large reason why his institution has decided to invest so heavily in population health.

This session instilled in me just how much the economic incentives surrounding how we pay for healthcare influences what the healthcare system will choose to value. At the center of our healthcare system should rest a well-resourced, population-health focused, primary care infrastructure. Unfortunately, that’s not the healthcare system we pay for, and not the one we have. This is something I’ve come to appreciate during my training as a primary care physician. So much attention in primary care is focused on billing for the individual clinic visit because our current reimbursement system makes that the livelihood of our primary care infrastructure. This leaves little room for population health management. It’s my hope to help redesign a healthcare system that preserves the physician-patient relationship, but also provides primary care providers the resources to focus on the health of populations.

VV: How has your work with VSSL contributed to your interest in, or ability to work on, the Task Force?

JS: The mentorship I’ve received at VSSL has been essential to my continued interest in studying primary care alternative payment models, and in helping me cultivate a skill set that I hope will be useful to the Task Force.

The mentorship I’ve received from Drs. Josh Liao and Leah Marcotte has helped me to understand population health oriented primary care APMs and the implications of individual model characteristics. Much of my work with VSSL has been focused on analyzing the Primary Care First model, an upcoming primary care focused APM sponsored by the Centers for Medicare and Medicaid Services. The HCA’s proposal for the Primary Care Transformation Model has several overlapping traits with Primary Care First.

Largely due to my experiences with VSSL, I feel well equipped to analyze upcoming iterations of the Health Care Authority’s model and consider how they may help or hinder primary care physicians’ ability to care for the population health of Washingtonians.

VV: What are up to 2-3 main things you hope to gain out of your work on the Task Force?

JS: I’m really quite humbled to have the opportunity to work with Washington Family Medicine leaders on the Primary Care Investment Task Force. From them, I hope to learn how policy changes are felt on the ground by long-term practicing primary care physicians. Residency is an immersive exercise in learning the practice of medicine, and I expect that participating in the Task Force will provide a similar education in the practice of healthcare in an ever evolving system. Additionally, I hope that working on the Task Force with experienced physician advocates will help me learn what it means to be a health systems advocate in medicine.

"Largely due to my experiences with VSSL, I feel well equipped to analyze upcoming iterations of the Health Care Authority’s model and consider how they may help or hinder primary care physicians’ ability to care for the population health of Washingtonians."

VV: Going forward, how will the Task Force work impact your work during residency more generally, or your work with VSSL more specifically?

JS: Much of my work with VSSL thus far has focused on programs and developments in the Medicare program. This is so fundamental to my learning since Medicare is the country’s largest payer, but of course Medicare is not the country’s only payer.

I hope that my experience on the Task Force will help expand my purview to state and local policy developments in payment reform, and help me understand what it means for primary care providers to navigate changing payment systems across multiple payers. Ultimately, there is no re-orienting our healthcare system to support population health without orienting this country’s multiple healthcare payer systems, and I hope my time on the Task Force will help me grow in my understanding of this interplay.