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. 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 value-based care.
What are some of the biggest challenges physicians face when transitioning to value-based care?
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 value-based care 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 that evidence-based tools make them better physicians and, as a result, they become highly supportive of value-based care.
How have you seen the relationship between quality care and physician financial stability evolve in value-based care?
Traditionally, these were challenging discussions given the deep roots of fee-for-service in healthcare. 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 value-based care 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 value-based care 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 healthcare system and the need to practice high-level evidence-based medicine, even if in some circumstances it results in decreased procedures and testing, find value-based care 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 value-based care?
Yes, value-based care 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 co-insurance, but we’re helping them avoid the risks from the procedure.
It’s often important to educate patients on what value-based care 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 value-based care, it doesn’t mean you’re skimping on care. It means we’re providing exactly the right care at a lower cost.
Does a value-based care model inspire collaboration between primary care physicians and specialists?
Specialists and primary care physicians become great partners in a value-based care 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 value-based care model ever dissuade critical care decisions?
Absolutely not. Fee-for-service has the potential to drive bad decision making, not value-based care.
We’ve seen value-based care 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.
Click here for information about how to succeed in value-based care.
About the author
Dr. Cohen was one of the founding physicians and served as chief medical officer of New West Physicians, the largest primary care group practice in Colorado, for 25 years before transitioning to his role with Optum Health, serving as the executive director of translational research.
Optum Health is dedicated to bringing all parts of the health care system together to make simpler, more effective and more affordable care available to everyone, when, where and how they need it.