In the fifth episode of This Clinical Life, I sat down with Jennifer Main Rutberg, MD, Medical Director of Care Coordination at Banner Health, to discuss the importance of value-based care in the exam room. Here are the highlights of our conversation.
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What is Value-Based Care?
In simple terms, value-based healthcare is a healthcare delivery model in which care systems are paid based on patient health outcomes. Under value-based care agreements, clinicians and organizations are rewarded for helping patients improve their health, reduce the effects and incidence of chronic disease, and live healthier lives in an evidence-based way.
Though value-based care has made some progress and has a fairly strong notional commitment among healthcare leaders, the fee-for-service model remains the mainstay in how American healthcare is delivered and paid for. At the moment, leaders are taking an incremental, toe-in-the-water approach to transitioning to value-based care, which is yielding steady, quiet, and subtle gains.
The Progress of Value-Based Care
“Compared to seven or eight years ago, we’ve doubled the number of physicians who are practicing under some value-based reimbursement model.” – Jennifer Main Rutberg, MD
In 2020, the Health Care Payment Learning & Action Network discovered that 60% of health care payments included some form of quality and value component. That is up from 53% in 2017 and 11% in 2012. Better still, 49% of practices responding to the American Academy of Family Physicians 2022 value-based care survey stated that they are involved in some form of value-based payment(1).
However, this is a far cry from where we aspire to be.
Healthcare expenditure was 18.3% of the United States GDP as of 2021 and continues to rise with over 200 billion in healthcare spending increases added annually anticipated over the next decade(2). With costs continuing to rise, value-based revenue in both primary and specialty care remains below 7 percent according to a recent MGMA survey(3). What’s more, medical expenses are among the top five reasons why individuals become bankrupt in the U.S(4). There is not a single medical professional or leader that wishes to cause such undue burden upon its patients, yet, we are unfortunately doing just that with a system that is costly, often wasteful, inaccessible, and not always dialed into the goals and priorities of patients.
So is there something that we can actually do to advance quality, patient participation, and team-based care, all the while reducing costs? Enter my conversation with Jennifer, where we review preparing clinicians to deliver high-value care through some simple principles.
Value-Based Care and the Individual Clinician
Dr. Rutberg and I reviewed the principles of care layers – policy, group, teams, and individual clinicians and agreed that for value to manifest, it must occur at the micro-interaction level, between clinicians and patients in the exam room. Value-based care is not a policy, health plan directive, or even a cost reduction strategy – value-based care is a fundamental shift in how we deliver care where we transition from reactive to proactive and preventative care. To this day, 86 percent of our resources are spent after disease is manifesting, missing massive opportunities for wellness preservation(5). Value-based care is adherence to evidence in all that we do. Currently, approximately 18 percent of clinical recommendations are backed by high-quality evidence(6). Value-based care is care by a team for the patients that are both on and off our schedule and tapping local team collaboration, innovations, and top-of-license enablement to care for a community of patients. Value-based care is identifying what matters to patients, and partnering with them to achieve their goals.
Dr. Rutberg and I discussed how we must stop seeing value-based care as a strategic initiative or conference topic but as a proactive, evidence-based, patient-centered way of caring for patients by teams that transcend into exam rooms as a shared commitment across organizations. We must reframe value-based care from policy and payer initiatives to clinical actions with the sensibilities that resonate and connect with clinicians’ commitment to the well-being of patients. A transition to value will require coupling value-based care to a commitment to better care, developing clinicians to provide high-value care, and making commitments to the components of care that deeply resonate with why we joined this healing profession.
“So often, the answer is in the patient’s story. What we do in the exam room is we ask questions and we listen; we build relationships and we build trust. That is our high power tool to bring value to patients.” – Jennifer Main Rutberg, MD
There is no doubt, every organization is on a different part of the value journey based on local conditions, cultures, the payer field, and health system priorities. So what can we do to begin the journey personally, and across our teams, ground up, to provide the most important benefits of value-based care? Here are a few suggestions by Dr. Rutburg:
• It starts with what your patient cares about most.
• Identifying patient goals as the context for care recommendations. Ask your patient, “What are you hoping to achieve in terms of your health? What daily activities or objectives are a priority for you to get back to?”
• By focusing on what matters most to patients, we are framing the care plan to their goals to facilitate engagement, participation, and enthusiasm for clinical recommendations.
• Stick to your pathways.
• Leverage evidence to help achieve their identified goals.
• When patients request unnecessary care, find the story behind the request, validate their worries, create a shared interest, and leverage trust and evidence to guide patients to proven care.
• Involve the entire team.
• Tapping teams to coach patients, sync up between visits, tap community resources, and meet with patients to advance wellness and keep patients out of high-acuity care centers is the foundation of value-based care.
• Empowering teammates to do more, bring ideas, make a difference, and contribute to care not only benefits patients as recipients of team-based care, but it is also a powerful engagement dial when team exhaustion and burnout is so challenging now.
• Double down on the preservation of health, social determinants, and a proactive mindset.
• In the context of wellness checks and follow-ups, become a fierce advocate for the true drivers of vitality. Exercise, sleep, nutrition, safety, food security, and the composite of life measures drive the majority of health outcomes.
• Find, identify, and respond to social determinants of health as a pathway to truly influence the wellness of populations, one patient at a time.
Seeing value-based care as simply a channel of team-based, patient-centered, evidence-based, preventative, whole-person care is sometimes more accessible, rational, and resonating for clinicians and their teams. I so appreciate Dr. Rutburg’s conversation about what makes value-based care come to life where she is. We are also very excited about our new Value-Based Care Program to help and support organizations who are beginning the journey to assure clinicians, teams and leaders bring the actions, skills, and mindsets to move to high-value care in a way that benefits communities, organizations, care teams, and the patients sitting at our elbow.
Sources cited:
- Bendix, J. (2022). Value-based care gains ground. 99. https://www.medicaleconomics.com/view/value-based-care-gains-ground
- U.S. health expenditure as GDP share 1960-2021. (n.d.). Statista. Retrieved May 24, 2023, from https://www.statista.com/statistics/184968/us-health-expenditure-as-percent-of-gdp-since-1960/
- 2022 MGMA Data Report—Patient Access and Value-Based Outcomes Amid the Great Attrition. (n.d.). Retrieved May 24, 2023, from https://www.mgma.com/data/landing-pages/2022-mgma-data-dive-practice-ops-report
- Top 5 Reasons Why People Go Bankrupt. (n.d.). Investopedia. Retrieved May 24, 2023, from https://www.investopedia.com/financial-edge/0310/top-5-reasons-people-go-bankrupt.aspx
- Holman, H. R. (2020). The Relation of the Chronic Disease Epidemic to the Health Care Crisis. ACR Open Rheumatology, 2(3), 167–173. https://doi.org/10.1002/acr2.11114
- Ebell, M. H., Sokol, R., Lee, A., Simons, C., & Early, J. (2017). How good is the evidence to support primary care practice? BMJ Evidence-Based Medicine, 22(3), 88–92. https://doi.org/10.1136/ebmed-2017-110704
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Stephen Beeson, MD is the CEO and founder of Practicing Excellence. An author of two national best-selling books, Dr. Beeson has become a national thought leader in building organizational approaches and cultures that support patient connection, team collaboration, and transformative leadership.
