Making Ends Meet While the Health Care System Changes

July 29, 2011

Virgilio Licona wants to provide evidence-based, accountable care to patients, but, so far, he doesn't actually get paid to do it. He's finding ways to make it happen anyway.

Virgilio Licona, a family physician, seeps old-school charm. His eyes connect; his handshake is more like affectionate hand holding. He is the sort of man who opens doors, pulls out chairs, and loves his patients. He proudly talks about how he got his start as a physician assistant. And his ponytail and turquoise-clasped bolo tie provide a window into his respect for the traditions and values of the underserved, and largely immigrant, populations he serves as associate medical director of Salud Family Health Centers, a system of eight primary care clinics, dotted in the communities that provide Colorado’s Front Range with agricultural and industrial labor.

But Licona’s graciousness masks a steely resolve. “I may look like an old man,” he smiles, “but I’m a twenty-second century warrior.”

His current battle? Finding ways to provide accountable, outcomes oriented care in a system still set up to pay for more care, not better care.

“We literally are in revolution,” Licona said while attending The Colorado Health Symposium and a session about the changing system. He describes a changing system full of demands. “I have a full plate in one hand, a full glass in the other, and now I’m being asked to balance something on my head.”

He is all too familiar with the hurdles: His electronic medical record now lets him review script requests in the evening-the last thing he wants to do. His staff is trained to do things like pull paper medical records, not help a diabetic patient struggling to find fruits and vegetables to eat in an industrial maze of factories and warehouses, no grocery store in sight. He’d love to add a social worker to his staff, but no one pays for that.

But Licona is determined to make it all work anyway. “I’m not whining. I say, ‘Bring it on.’”
The future and the best course for patients lies in accountable care that treats the whole patient, is based on evidence, and measures outcomes, he feels. “We aren’t taking a vote. It has been decided.”

So the only thing to do is the best you can while the transition continues.

Licona got his EMR. He is training his existing staff to take on roles they hadn’t imagined. He applies for grants. He holds group visits. He brooks no resistance from fellow physicians who think patient affection can take the place of measured results. And he trains young physicians in the new world order. We have to “regulate the old and educate the young,” he insists.

He is but one of thousands of primary care physicians trying to do at least two things at once: Get paid for how much you do, while trying to change process and tools so that you-and ultimately your patients-can prepare to win for how well you do.

What are you doing to bridge the gap? Or does it seem too big a canyon?