Financial performance
Marrying clinical results and financial stability in value-based care
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Dr. Cohen
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Myth: VBC focuses too much on revenue, dissuades critical care decisions
Kenneth Cohen, MD, FACP, is a physician leader, practicing physician and researcher who has devoted his career to advancing evidence-based medicine and delivering value-based care (VBC). Throughout his career, Dr. Cohen has successfully developed, directed, evaluated and reported numerous clinical quality studies in primary care.
In this Q&A, Dr. Cohen shares key insights about the clinical and financial impacts of VBC.
What are some of the biggest challenges physicians face when transitioning to VBC?
Primary care medicine is an extraordinarily difficult job given the tasks required to complete a day’s work. Finding the time to dedicate to value-based care education can be problematic in an already busy workday.
However, with the right educational initiatives that make the latest research in evidence-based medicine digestible and accessible, it’s easier for physicians to grasp and implement VBC programs. In my experience, it takes a dedicated team to sift through studies and journals and present the information in a succinct manner, such as downloadable continuing medical education (CME) audio and print format briefs. We’ve had a lot of success with recorded lecture series and lunch and learns, all CME accredited, as well.
Once physicians are given these opportunities to learn evolving evidence-based-care best practices, they quickly begin to apply changes and experience efficiencies in their practices that make their day-to-day life easier.
They understand evidence-based tools make them better physicians and, as a result, they become highly supportive of VBC.
How have you seen the relationship between quality care and physician financial stability evolve in VBC?
Traditionally, these were challenging discussions given the deep roots of feefor-service in health care. However, there have been enough studies in chronic disease management and acute care, demonstrating both positive patient health and financial outcomes, that it’s becoming easier.
What VBC has proven in diabetes management, spinal care, cardiology procedures and more is by practicing evidence-based care, physicians do not experience any meaningful financial difference by getting off the hamster wheel when delivering care to patients. A VBC model engages and educates patients so there’s a true partnership in achieving better outcomes versus a fee-for-service model built around patient volume.
Physicians who understand the inefficiencies in our health care system and the need to practice high-level evidence-based medicine, even if in some circumstances it results in decreased procedures and testing, find VBC to be more lucrative and financially predictable in the end. This is well established in primary care and continues to evolve in specialty care.
Do patients experience better care and positive financial benefits from VBC?
Yes, VBC has a significant impact on patients’ results and finances. By routing patients to appropriate care in the right setting, they benefit as the total cost of care is reduced and they avoid unnecessary testing and procedures.
For example, there is a new technology called coronary artery CTA where you can essentially do a virtual heart catheterization. It was used for the evaluation of stable chest pain in three large, well-done trials, and they all showed that it’s possible to reduce unnecessary heart catheterizations by 75%. By avoiding a heart catheterization, we’re not only saving patients coinsurance, but we’re helping them avoid the risks from the procedure.
It’s often important to educate patients on what VBC means to them. They can confuse service with quality and believe more care is better care, which is not accurate. It’s important to educate patients that with VBC doesn’t mean you’re skimping on care.
It means we’re providing exactly the right care at a lower cost.
Does a VBC model inspire collaboration between primary care physicians and specialists?
Specialists and primary care physicians become great partners in a VBC model.
With evidence-based medicine, they’re united around the patient and the treatment that delivers the best possible outcome. In some areas, we’ve seen instances where the number of procedures may be reduced for specialists, but in the long term, they end up with more referrals because they’re highly engaged with primary care physicians and have regular conversations about new evidence and best practices.
Having this level of collaboration is highly beneficial for patients who experience increased access to care, a seamless handoff to specialists and, ultimately, better health outcomes.
Does a VBC model ever dissuade critical care decisions?
Absolutely not. Fee-for-service has the potential to drive bad decision-making, not VBC.
We’ve seen VBC play out for over a decade, and physicians are very good at prioritizing evidence-based outcomes.
In a care model focused on outcomes, patients receive excellent care in the appropriate setting. For example, we had a patient suffering from severe lower back pain and had previously seen a surgeon who recommended surgery. When he came to our facility, we were able to route him to our back pain program that focused on core strengthening techniques, cognitive therapies and a whole range of treatments available outside of a surgical setting. These therapies helped him avoid surgery and resolved his pain.
Rather than directing him to a surgical option with higher risk and significant downtime, our value-based model ensured we explored other treatments that, in the end, produced excellent results.
About Ken Cohen, MD, FACP
Dr. Cohen was one of the founding physicians of New West Physicians, which is the largest primary care group practice in Colorado. He served as chief medical officer for New West Physicians for 25 years before transitioning to his role with Optum Health, serving as the executive director of translational research.
Dr. Cohen also teaches, and he serves as a preceptor for medical students. He is a clinical associate professor of medicine and pharmacy at the University of Colorado School of Medicine.
Dr. Cohen holds degrees from Dickinson College (Phi Beta Kappa) and Hahnemann University (Alpha Omega Alpha). He is a fellow of the American College of Physicians and a diplomate of the American Board of Internal Medicine.
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