As a physician leader who coaches other physician leaders, I can attest to the fact that the design of value-based care requires physician participation. The tough decisions about what is value-added, cost-effective care—as opposed to costly waste—must be made by clinicians who understand the medial science that supports appropriate clinical protocols. Physicians must decide whether a test, treatment, procedure, or drug will save more than it costs in the prevention of downstream illness.
This, in turn, requires physician leaders to find ways to engage busy physicians in the value-based care process. Many leaders bring physicians into the transition process through meetings and information sharing, but this poses a problem for physicians because they lose precious hours of productivity by attending meetings. When they’re not seeing patients, they’re not being compensated. One approach is to consider paying physicians for their time in meetings.
But physician leaders must do more than entice physicians to attend meetings. They must master the skills of persuasion, change management, and incentive alignment. They must engage their colleagues in the entire process of care redesign.
Physician leaders must become savvy about finance and cost accounting. They need to understand actuarial science, predictive modeling, and the health information technology (HIT) that allows them to predict the effect of a clinical initiative on downstream morbidity and claims expense.
Predictive modeling in population health has another implication for physician leaders. They must think in terms of populations—and help their colleagues do so—rather than just in terms of the individual before them. As professionals, physicians will always have a moral obligation to respond to the needs of the individual who seeks their care. Individuals vary. There are legitimate reasons to deviate from standard protocols. We affirm that physicians should use their judgment to make such accommodations.
At the same time, we have an obligation to patients as members of a group to keep their insurance premiums under control. This obligation requires physician leaders to enlist their colleagues in following evidence-based guidelines as general rules so they don’t waste resources or fail to prevent illness.
The implication for physician leaders in population health is that they must learn to provide feedback appropriately and in a supportive fashion. Feedback should be given to improve care in general, not to micromanage. The n sizes are often too small, the patient risk factors are inadequately accounted for, and the attribution methods are too clumsy to use clinical quality metrics as a micromanagement tool.
Effective physician leaders look at the performance of groups of providers and see which have developed best practices and workflows that can be shared with others for the overall benefit of the population. They build a culture of quality improvement.
Physician leaders in value-based care must become as good at communication and persuasion as they are at science. They must become proficient in team-based care and team-based problem solving. They will benefit greatly from devising ways to support and unburden providers through care management, technology, and the provision of accurate and actionable information, rather than driving them to check more boxes and follow blindly.