By Bruce Cohen, M.D., Medical Advisor, Calm Waters AI
As a practicing physician today, I hear a lot about value-based care: It’s coming, and it’s big. But I am not sure there is much understanding of how value-based care will affect each one of us.
I think we all agree that the current healthcare system in the US is broken, and something must be done. Between 17%-18% of this country’s gross domestic product (GDP) goes toward healthcare. That’s considerably more than any of the other ten nations in the OECD (Organization for Economic Cooperation and Development). And yet we rank dead last in this group on such vital measures as healthcare outcomes, access to care, equity, and administrative efficiency, according to the Commonwealth Fund.[1] Our quality and life expectancy figures put us just in the middle of the pack in developed countries. And on top of everything else, our system is confusing and difficult to navigate.
We, as providers, must participate in reforming the system—and in ensuring that it delivers more value for the dollars spent on healthcare.
From a primary care perspective, getting involved in risk-bearing contracts and helping manage the health of the lives attributed to you is that opportunity. It is now critical to appropriately document your patient visits and reconcile their diagnoses to attribute risk and acuity accurately.
I hear over and over from providers that “I don’t have time to do this.” And it’s true. Providers are already so heavily burdened with documentation and paperwork that it is becoming a major contributor to burnout.
We are faced with the choice of either enlisting more help or leveraging technology to accomplish the goals we’re asked to meet. Unfortunately, enlisting more help through scribes and extenders is expensive, and the cost is challenging to justify amid declining reimbursement and increasing overhead. We need to embrace technology and explore new solutions to these problems. The same goes for remote patient monitoring and chronic disease management, which provide opportunities to lower the cost of care while improving quality.
As surgical specialists, our challenge is to provide low-cost, high-quality care in an episodic manner. Transitioning the site of service for procedures from the high-cost setting in hospitals to ambulatory surgery centers and in-office procedure rooms is critical to achieving these goals. But how do we ensure that our patients are progressing well? Even more importantly, how do we prevent complications and expensive trips to the ER? We must embrace, refine, and implement innovative ways to communicate with our patients and provide feedback and information. Eventually, our specialists will be responsible for cost containment, whether through episodic, risk-bearing contracts or as part of a population health approach. We must work to first measure and track our outcomes—and then to improve these outcomes.
While these concepts seem unrealistic and academic, they are not. We, as providers, are the ones who can lead the reform of our broken system. Open your minds and prepare to innovate.
Bruce Cohen, M.D., is the former CEO of OrthoCarolina.
[1] Commonwealth Fund Reports, “Mirror, Mirror 2021: Reflecting Poorly,” August 4, 2021: https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly