For Mid-Atlantic Permanente Medical Group (MAPMG), technology is not merely a support tool—it has become the engine that powers a highly coordinated, data-driven model of value-based care. As the independent multispecialty medical group caring for nearly 800,000 Kaiser Permanente members across Washington, D.C., Maryland and Virginia, MAPMG has built a fully capitated structure in which improving outcomes and lowering cost are inseparable goals.
Richard McCarthy, MD, a neurologist and executive medical director of MAPMG, described how this approach works during the AMA STEPS Forward® webinar, “Reimagining Value-Based Care: How Technology Is Transforming Data Collaboration.” His perspective centers on a core belief: Reliable, clinically relevant data—vetted by the people delivering care—is the essential backbone of sustainable value-based performance.
“There’s the Kaiser Foundation Health Plan, which is a national health insurance company that contracts with independent multi-specialty groups, one of which is the Mid-Atlantic Permanente Medical Group,” said Dr. McCarthy. “We are fully capitated in this population-based management payment organization. And for us, data is critical because we're paid based on quality, patient service experience and access to care outcomes.”
From this structure flow, MAPMG’s operational priorities are: measure what matters, embed the data where clinicians work, and ensure that improvement is achievable, fair and grounded in the frontline experience.
Mid-Atlantic Permanente Medical Group 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.
A model built on outcomes and trust
MAPMG’s architecture for value-based care starts with a simple equation: value equals high-quality outcomes and strong experience divided by total cost of care. Better quality and service experience increases value for patients at MAPMG. Meanwhile, non-value-added increased cost of care which results in higher health insurance premiums and decreases value for our patients.
But expressing value through the symbol of a mathematical equation is not enough. Leaders must ensure the data behind each component is both clinically meaningful and operationally credible.
“We have a single payer—that's the Kaiser Foundation Health Plan—and the way we look at data is really surrounding adding value to a patient,” Dr. McCarthy said. “We look at operational data related to patient experience, physician and staff experience, and quality outcomes as the numerator, and then total cost of care as the denominator.”
MAPMG’s analytics operations are large and sophisticated, but size alone is not sufficient. What matters, Dr. McCarthy emphasized, is vetting and validating each measure with physicians and nurses before it becomes part of practice expectations or performance dashboards.
“For us, what's really important is that the data we use for each part of our equation to provide the highest quality of care, the best experience … and the lowest total cost of care is the vetting that we do with the folks doing the work to make sure that our data is operationally relevant,” he said.
Reports are not created in isolation. They are reviewed with frontline physicians and operational leaders, who check whether the numbers reflect the reality of clinical operations.
“Ideally, a key to getting great outcomes is to really engage physicians and nurses in the data itself,” Dr. McCarthy said. “And have them buy in to the validity of the information that's being received.”
This vetting process is the difference between data as an improvement tool and data as a punitive instrument—something MAPMG avoids. They prefer to focus more on the slope of improvement of data as much as the absolute number representing performance to goal.
Making data accessible, usable and meaningful
Physicians are more motivated by actionable information than by abstract benchmarks. The best tactics, said Dr. McCarthy, balance multiple drivers of value—patient experience, physician experience, cost and quality—rather than treating any single input as the priority.
“A tactic that just focuses on the total cost of care is going to fail,” he said. “A tactic that just focuses on patient satisfaction is going to fail. A tactic that focuses on the combination of patient satisfaction, physician satisfaction, increased quality of care, and lower total cost of care is what will really win.”
This is where MAPMG’s technology investments (PDF) come in. Remote monitoring programs for diabetes, hypertension, pregnancy and “advanced care at home” are central examples. They generate continuous patient data, but that information must move seamlessly into the clinical workflow.
“We're big fans of remote data monitoring,” he said. “The key is accessibility to physician practice. The data is only useful if it's easily accessible to a busy clinician who can incorporate it into their incredibly busy day seeing patients back-to-back.”
To avoid reservoirs of unused information, MAPMG embeds data into the tools physicians already rely on—particularly the EHR—which ensures relevance and reduces cognitive load.
“The future of health care is care at home, including remote monitoring,” Dr. McCarthy said. “It offers real value, but only if it's accessible to the clinicians doing the work in a way that's reasonable for them to use it to improve care.”
Driving improvement through dashboards, iteration and frontline innovation
Performance dashboards are foundational to MAPMG’s data strategy, but they are created through collaboration—not top-down decree.
“When you're looking at performance data, make sure that it's iterated well in the beginning with the people doing the work,” Dr. McCarthy said. “We have performance dashboards for various specialties, and what we do is engage specialists or primary care docs in what excellent looks like in your practice.”
Physicians and other health professionals help determine which metrics matter most and what goals are achievable. They also help limit unnecessary metrics. Equally important is allowing physicians freedom to experiment with solutions.
“You’re allowing people to innovate changes in process and local tactics, and you accept that it’s OK to fail fast and then try something else,” Dr. McCarthy said.
An oversight function within the medical group then identifies best practices and disseminates them—a cycle that both supports local creativity and enables systemwide learning.
“You’re never done,” Dr. McCarthy said. “Where you are in time and space is less important than your slope. What you want to do is make sure you're encouraging people to increase the slope of improvement and feel ownership.”
To achieve this, data must be accurate, trustworthy, and checked thoroughly at the start.
AI as an accelerator of value
Dr. McCarthy also highlighted how augmented intelligence (AI)—also known as artificial intelligence—and machine learning tools, especially ambient documentation, are poised to enhance both value-based performance and the human experience of care.
“The most exciting thing is that it really puts all of the technical aspects of medical care a little bit in the backseat so that physicians can focus more on the relationship aspects,” he said. “That in some ways is as important, and sometimes more important, than the technical part.”
MAPMG is also already using AI for diagnostic support.
“In the Mid-Atlantic, we use AI to help second read for pathology and in radiology as well,” he said.
They are also exploring AI-driven support for patient messages and clinical documentation—systems that generate drafts and allow physicians to edit, refine, and publish.
“It enables physicians to edit and publish both in terms of diagnostic work and also in terms of patient communications, and saves innumerable hours for busy docs,” Dr. McCarthy said. “AI is going to transform physician practice. My hope is that it will not only improve quality and safety but also help improve the practice of medicine and get docs back to what really is soul-enriching for them.”
Build data-driven value-based care
For leaders navigating the shift toward data-driven, technology-enabled value, Dr. McCarthy emphasized that “whatever you can do to get data to move operations, that’s critically important.”
But he also reinforced that leaders must avoid assuming they are the primary problem-solvers.
“Even though it's really fun to solve problems as leaders, make sure to remember that solutions come from people doing the work, not from you,” Dr. McCarthy said. “Your role is to curate the best data for the most relevant pain points and then let folks doing the work be free to find solutions, fail fast or identify best practices.”
Ultimately, he said, data and technology matter most when they empower physicians and accelerate improvements that patients can experience.
Learn more with the AMA about value-based care, including ways to improve data sharing and best practices for payment methods.
