The concept of value-based care is not a new one. Since Medicare’s development of diagnosis-related groups (DRGs) in the early 1980s, providers have been asked to improve the processes and outcomes associated with quality, and to be better stewards of healthcare costs and utilization.
Better pay for better performance is a concept that we can all support, but the underlying question we have to ask ourselves is: Are our quality initiatives and measures truly evidence-based and proven to lead to reduction in morbidity and mortality? As we move further down the path toward value-based care, the role of the physician leader should become one of advocacy for developing more meaningful measures, prevention of provider frustration, and defining value from our patients’ perspectives.
Immunizations, cancer screenings, and chronic disease management are all great examples of preventive medicine. When practiced properly and coupled with strong patient engagement, the benefits overwhelmingly outweigh the costs. This does not mean that payers should adopt extensive lists of potential measures to influence the process or outcomes in a value-based payment model.
The Physician Leader’s Role
A physician leader should play a pivotal role in negotiations regarding value-based measures, with a focus on:
- Less is better than more.
- A drive toward outcomes where the affected patient populations are easily defined.
- The benefits are clear.
Many physician leaders find themselves dealing with providers’ frustrations when it comes to the administrative burden and reduction of patient face time associated with the growing focus on value-based quality measures. These pressures can have a negative effect on the physician leader, creating a sense of being in constant confrontation, which can lead to burnout.
The physician leader should take on the roles of advocate and supporter for his or her team when working with network providers. Actively listening to colleagues’ concerns, showing respect for their professional expertise, engaging in solution development, and reassuring them about negotiations to limit the number of measures can go a long way toward fostering supportive working relationships.
Consider the Patient’s Perspective
It is rare that we think about the definition of value-based care according to our patients. Many things stand in the way, including cultural norms, health literacy, and other disparities. Engaging in basic inquiry and listening to our patients’ desires and needs can provide valuable insight. Social determinants of health don’t always lend themselves to achieving high scores on certain quality metrics. Over-testing and the risk of false positives can sometimes cause more harm than good. Physician leaders, in collaboration with frontline providers, need to be advocates for patients when it comes to these new and expanding payer expectations.
Experience has taught us that it’s not that easy to achieve all the goals of value-based care and population health. There’s always the opportunity to improve, but a cookie-cutter approach is not feasible. Physician leaders need to be willing to speak up and bring sensibility to the mounting requirements and growth of questionable measures to be the best advocates for all the stakeholders who care about improvement.
Doug Ardoin, MD, MBA, managing principal for Lumina Health Partners, is a physician executive with more than 14 years of leadership experience serving in large healthcare systems. He is certified by the American Board of Family Medicine (ABFM) and a Fellow of the American Academy of Family Physicians (AAFP).