Overdrive Podcast: Value-Based Care in Rheumatology

Below is a snippet of our conversation:

Rheumatology Network: What are the benefits of value-based care and how does it allow for personalized patient care?

Andrew L Concoff, MD, FACR, CAQSM: There are several benefits in a successful value-based care program. You could say that there's the opportunity to lower costs of care, and you could say that there's the opportunity to improve outcomes. And really, that's where I would focus. It really puts a premium on delivering outcomes for individual patients. And this is what precision medicine is all about. When I go to see the doctor, I care about how I am going to end up doing. I don't care about the average patient; I don't care about the typical patient. And I don't particularly care about the doctor seeing a ton of other patients. I want my care to be excellent and my outcomes to be excellent. And that's really what these value-based care programs are about. It's about assessing the individual and assessing the individual's journey and the individual's response. And in rheumatology, we're still in the process of adapting this treat-to-target model where we're assessing patients before and after an intervention and response and how they respond on an individual level to guide changes in their care. Unfortunately, this has not been as widely adopted yet in the United States, because we know that it yields better outcomes and lower costs for the system. And right now, I think a critical thing to understand about this is that those doctors that are doing a great job are not getting paid for doing a great job they're doing. They're getting paid the same if they do a great job or not. You could say that word of mouth can increase how busy they are in their practice, but at least formally, the way that they're being compensated is not about the quality of care they deliver. Any doctor that's doing a great job out there is doing it because they believe in that because of the good graces of their heart. And because it's generally good for business, this value-based care approach directly compensates doctors for generating good outcomes.

RN: How does a collaborative approach to working with payers benefit practices and patients?

AC: I worked in a sort of adversarial relationships for 20 years with payers before I came to this value-based approach and got more and more enamored with it. Now that's what I do all day. It used to be that it was sort of like the Hatfields and the McCoys in my clinic where we felt like the insurance companies were doing it to us again. The problem was that that wasn't a very productive way of interacting and it didn't actually work when you think of it as a zero-sum game. That is, every dollar that I make is $1 that the insurance company isn't making. That's sort of the way that we looked at. The fact of the matter is in our healthcare system, there's a different role that a health plan has and that clinicians have and the priorities are different. What these value-based care programs allow is to create a Venn diagram of our needs on the clinician side, on the health plan needs, and overlap those and create programs that bring the best of the intentions of both sides to bear on the patient care and brings patients along. And so the opportunity is to build relationships and build understanding between clinicians, or clinician groups like United Rheumatology, where I work, that creates these linkages between health plans and clinicians. And the more that we work together, the more that we understand one another, the more that we recognize opportunities to work together. You can think of, for instance, in this fragmented healthcare landscape- the United States, unlike a lot of European countries, I'd like to think of these value-based programs as a data bridge, that on the one side of the river we have the clinicians building a bridge, and the data is the steel they use to build that bridge. What kind of data is that disease specific activity measures, for instance like a CDAI, in rheumatoid arthritis? And we know how active the patient's disease is at a given time, but the payer has no idea about how a patient is doing. And then there's this big gap in the middle of a river on the other side. They're building a bridge toward us in these programs, and their data, their steel, that they're building that bridge from his medical claims data, that they have these other forms of information that we don't have access to. And in our healthcare system, typically, there's been a huge gap in between those 2 data sets. And what these programs do is they link them together like a bridge, and we share information. On the other side of the fence, the health plan shares information. And only by sharing that information and bringing that data together, can we determine what the best approaches are from an outcome perspective for the patients and from a cost of care perspective for the system.