Paving the Path to Success: Teaching Doctors Value-Based Care

March 09, 2020 - The way physicians have historically provided care – and gotten paid for it – is not working for most industry stakeholders. Smartphones, telehealth, and other innovative technologies are redefining the doctor-patient relationship, while value-based care models are turning the provider business model on its head.

These trends, and more, have led to a value-based transformation in healthcare. Physicians and other providers are now thinking of the value of care they provide to patients, and even the value of care they do not provide in certain circumstances. And their pay depends on it.

After nearly a decade of reform, fee-for-service (FFS) is no longer the norm, according to the latest data from the Health Care Payment Learning and Action Network. But still, physicians are struggling to shift all of their businesses and patients to value-based care models.

Only about a third of non-FFS healthcare payments came from an alternative payment model in 2018, the most recent year for which researchers had complete data. The remaining non-FFS payments merely tied FFS to some value or quality metric.

The transition to value-based care has been slow and steady as physicians figure out how to transform their entire business. However, many industry leaders fear time is running out – national healthcare spending growth continues to rise at an unsustainable rate while patient outcomes are not getting better.

READ MORE: Entering the Next Phase of Value-Based Care, Payment Reform

Part of the problem with the value-based care transition is that physicians aren’t taught how the healthcare industry works, said the American Medical Association’s Susan Skochelak, MD.

“For 20 years, I taught at the University of Wisconsin and it would surprise me to realize that medical students were graduating, for example, not knowing the difference between Medicare and Medicaid,” she recently told RevCycleIntelligence. “That is a basic understanding of our system.”

The ABCs of VBC

Stepping into her current role as the group vice president for medical education at the AMA, Skochelak also identified other basic understandings missing from medical school curricula, including team-based care, patient safety, and value in healthcare. The AMA went on to categorize these items as “health system sciences” and named it the third pillar of good care following basic science and clinical science.

“Medical education has historically been focused on the doctor and the patient,” she explained. “So, we've been very comfortable saying we need to understand the disease mechanisms and we need to know about treatment. We need to know how to diagnose one-on-one with a patient in your office. But in order to improve the patient's health and the nation's health, we're not doing a good enough job.”

“If we really want to do the best by our patients and communities, we can't stop at diagnosis and treatment. That's putting your head in the sand nowadays when we're all working in complex systems and patients are trying to figure out how to get through the systems.”

READ MORE: Best Practices for Value-Based Purchasing Implementation

To put health system sciences into practice, Skochelak now leads AMA’s Accelerating Change in Medical Education Initiative, which was launched in 2013 to “bridge the gaps that exist between how medical students are trained and how health care is delivered.”

As part of the initiative, the AMA is “creating the medical schools of the future” and “reimaging residency” by partnering with medical schools to implement health system sciences into curricula. The initiative started by providing grants to 11 medical schools in 2013 – just a small fraction of the 85 percent of all medical schools that answered the AMA’s request at the time – and has since expanded its partnerships to 37 medical schools.

“That tells you schools know and understand that this is important,” Skochelak said. “What's often keeping them from making these changes is that they don't always have the marginal resources to develop this material or the expertise.”

The AMA is also helping on that front, developing textbooks and exam questions for the United States Medical Licensing Examination (USMLE). Through its Health System Science Academy, the organization is also addressing faculty development needs by bringing experts on site, offering a free education hub platform on its website, and developing more resources like textbooks.

With a presence in a fifth of allopathic and osteopathic medical schools nationwide, the AMA is paving the path for more efficient, high-value care by educating future doctors on how the healthcare system works. Using that knowledge, Skochelak hopes the next group of physicians will be able to make meaningful change for the better.

READ MORE: Providers Lagging with Value-Based Care, Consumer Strategy

But educators and organizations like the AMA are also placing their bets on practicing physicians.

Teaching practicing providers

The healthcare system is in dire need of change, and many industry leaders believe more value-based care will improve the current situation. That is why universities like Boise State University created value-based healthcare certifications and accreditations.

“There’s very little education out there for value-based healthcare and how to be successful,” Jenni Gudapati, MBA, RN, value-based healthcare program director at Boise State University, told RevCycleIntelligence. “We decided that we were going to hit this head on.”

The university developed a 21-week course primarily done online for “those in healthcare who are interested in making the transition from volume to value-based payment arrangements.” To support organizations seeking to further progress with value-based care implementation, the certificate program provides lessons on a wide range of value-based topics, including:

• The development of the healthcare system, value-based reimbursement models, and possible future models
• Integration of public and population health, as well as behavioral health, with medical care
• Improvement of patient care experience through telehealth and other communication methods
• Use of patient-reported measures
• Efficient cost-allocation techniques
• Shared decision-making
• Evaluation of transformation effectiveness

“Students learn the history of payment, looking at Medicare, looking at fee-for-service, looking at the financial aspects of why we can't continue down the road that we've been,” Gudapati stated. “We dive into the different models and we go through definitions of what value-based healthcare actually is. We are establishing a common understanding of what value-based healthcare is, what the models mean, and then from that point, we start looking at ways to be successful.”

Other value-based healthcare certificate programs at universities like Dartmouth and Johns Hopkins are covering similar topics (e.g., healthcare finance, shared decision-making, and team-based care). But some of the programs are doing it in a more modern manner – online.

Boise State’s program is done completely online except for a one day in-person meeting in which Gudapati meets participants where they are.

The online structure also allows for the certification program to not only reach more educators and providers, like those who live in rural areas and don’t have the resources to attend classes in person, but it also enables providers to imagine a more technology-driven healthcare system.

“That's the other reason we wanted to integrate a technology piece into this,” Gudapati said. “When you are trying to build a program in a state that ranks 48th in the nation for access, you have to make improving access a key point and a key metric.”

The value-based healthcare program has been met with a lot of interest from providers and payers across the continuum, according to Gudapati. But these programs are not meant to last forever.

“In the real world, I would like to think that this value-based healthcare program will be, I don't want to say short-lived, but 15 years down the road that this isn't a class that needs to be taught because of the fact that this new model and this new way of looking at healthcare delivery becomes ingrained in the typical programs that are out there,” she explained.

With the help of current value-based healthcare programs and medical education initiatives, practicing physicians and future doctors are benefiting from more education. And by arming physicians with knowledge about healthcare finance, payment models, team-based care, and other ways of delivering high-quality, efficient care, industry leaders envision a better healthcare system.

“We want our junior colleagues, our young physicians, and trainers to be leaders in the future and to have a voice,” Skochelak said. “In order to have an impact on payment system reform or EHR reform or how to work better with communities, they need to have an understanding of the system, and they shouldn’t need to get an MBA to be an expert in healthcare financing.”