Internist Jerome Finkel, MD, prefers the term “high-value care” to “value-based care.” To him, high-value care can exist irrespective of payer or payment methodology, and it should be high quality, affordable, sustainable and deliver a great patient experience.
“Whether you're being reimbursed on the basis of fee for service, capitation, pay for performance, bundled payments or shared savings, shouldn’t matter. High-value care should be delivered across the entire care continuum, irrespective of reimbursement methodology,” said Dr. Finkel, who is also chief medical officer of the Value-Based Enterprise at Henry Ford Health in Detroit.
Henry Ford Health is part of the AMA Health System Member Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
The health system’s applications of high-value care have reduced hospital readmissions and improved outcomes for breast and colorectal cancer, and eye health.
During an “AMA STEPS Forward® Podcast” episode entitled “How Value-Based Care Empowers Health Systems,” Dr. Finkel joined Sea Chen, MD, PhD, to discuss Henry Ford Health’s transformation in high-value care, offering advice on navigating physician buy-in and other challenges unique to this model.
The evolving landscape of value-based care
Value-based care is a complex topic. It means different things to different people, noted Dr. Chen, who is physician director of practice sustainability at the AMA. He is also the clinical leader of the team’s initiatives on business of medicine and private practice.
Care methods are changing as health systems embrace the notion of high-value care, acknowledged Dr. Finkel. The focus is more on prevention, early detection and proactive care. Physicians and other health professionals are using predictive analytics to identify which subgroups of patients need the most care and attention, rather than the traditional passive approach which lacks the detailed understanding of the population we serve.
Some high needs patients may never visit their primary care physician. That is why an effective, high-value care team proactively reaches out to these patients using a technology-enabled, team-based care model that also addresses social factors affecting their health, said Dr. Finkel.
Persistent follow-ups lead to early detection of colorectal cancer and other preventable conditions. As an example, he shared one such patient’s experience. The patient had received 13 reminders about colorectal cancer screening through messages and during office visits. A year later, she finally had a colonoscopy, which revealed early-stage colon cancer. Because it was caught so soon, the condition was curable, he said.
Implementing high-value care
Henry Ford Health's journey towards high-value care began decades ago, driven in part by challenges such as federal and statewide regulations, demographic shifts—the aging population, the chronic disease epidemic—and workforce shortages. Recognizing the need for high-value care, Henry Ford Health leaders created a Value-Based Enterprise with the goal of facilitating and resourcing the journey to high-value care.
Implementing high-value care required a shift in mindset, integrating specialized care with population health.
“We're talking about everything from our operating plan to our structure, our reporting mechanisms, our incentive methodology,” to ensure the highest-value care for Henry Ford Health’s patient communities,” said Dr. Finkel.
It was a difficult journey that called for persistence, passion and tenacity within leadership, not to mention data and education, he added.
Learn more with the AMA about value-based care, including ways to improve data sharing and best practices for payment methods.
Eight “C’s” for driving physician buy-in
Physician buy-in poses a specific challenge with value-based care implementation, noted Dr. Finkel. His own personal solution? Applying the eight “Cs” of driving physician behavior: competence, competition, compensation, control, complexity reduction, collegiality, clarity and communication.
Each strategy will resonate differently among physicians. For example, some physicians respond strongly to control, while others are driven by competition. To tap into that, performance metrics are fully transparent—everyone can see the rankings—which adds a gamified element that encourages physicians to focus on key areas for improvement and fuels their competitive spirit.
Some doctors may also seek “control,” for a sense that their voice is being heard, that they have a say in what they’re going to do.
“We try to involve physicians every step of the way,” Dr. Finkel said. For example, Henry Ford Health encourages its physicians to play a role in defining its value-based care metrics, based on their level of interest and input.
Another important factor is compensation, which remains a core part of motivating and incentivizing performance.
Regarding communication, physicians can miss or misunderstand information, even if it’s shared repeatedly and across multiple channels. That’s why communicating frequently, broadly and with clarity, is so important, he elaborated.
Dr. Finkel encouraged health systems to employ the eight Cs when starting a new initiative because “if you touch most all of these, you'll be much better off in terms of your efforts to try to achieve behavioral change.”
High-value care drives preventive screenings
Through its high-value care initiatives, Henry Ford Health has increased breast cancer screening rates and improved Healthcare Effectiveness Data and Information Set measures, which helped avoid late-stage breast cancer cases. The health system also established 15 urgent care centers to provide accessible care and reduce unnecessary emergency department visits.
“When you think that breast cancer affects one in eight women … we saw ourselves being able to improve screening and cut the cost of care by providing easy access and the appropriate site of care for patients,” Dr. Finkel explained.
Additionally, Henry Ford Health introduced retina exams in offices, identifying preventable vision-threatening conditions in about 300 patients.
The system also managed chronic conditions, such as congestive heart failure, through early intervention and remote patient monitoring, reducing emergency department visits and hospital readmissions.
Practical guidance for emerging physician leaders
Looking forward, Henry Ford Health wants to prioritize engagement to combat physician burnout and doctor shortages, aiming to enhance joy in medicine, said Dr. Finkel.
He emphasized the importance of the integration of care and partnerships with payers to improve community health and reduce preventable services such as emergency department visits.
“Unfortunately, there's been a fairly adversarial relationship between payers and providers,” he said, adding that both parties should work together to share data and insights about the populations they serve.
Education and awareness about high-value care are also key priorities, with a focus on managing the full cost and quality of patient care.
When asked to share some pearls of wisdom for championing high-value care, Dr. Finkel advised that the first step is to address common misconceptions, reframing it as a shared goal across the entire care continuum.
High-value care is something most people can support, since it ultimately benefits both patients and providers, he noted.
Dr. Finkel also recommended working closely with finance and analytics teams to connect high-value care to both clinical outcomes and the organization’s financial performance. Using data to demonstrate its impact is essential, and the value should extend beyond shared savings alone, he said.
“The last bit of advice is to hang in there. I truly believe our nation's future depends on us getting this right,” Dr. Finkel said. “Let's continue this journey to create a sustainable health care delivery system for our nation and for our children. And in my case, for our grandchildren.”
AMA STEPS Forward offers real-world solutions to common challenges in health care today. Explore a variety of innovative, physician-developed resources designed to help prevent physician burnout, optimize workflows, improve well-being, and enhance patient care.
