Payment & Delivery Models

What can make value-based care shine? Go behind the scenes

Marc Zarefsky , Contributing News Writer

Maria Ansari, MD, joined The Permanente Medical Group 20 years ago in part because of a statistic: Northern California residents who were Kaiser Permanente members were 30% less likely to die from heart disease or stroke than nonmembers. As a cardiologist, Dr. Ansari was impressed.

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What she discovered upon joining was that superior patient outcome was due to an overwhelming emphasis on value-based care.

"It's because of the system," said Dr. Ansari who is the CEO and executive director of The Permanente Medical Group—a member of the AMA Health System Program that provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.

"It's being able to control hypertension and diabetes, and really doing that proactive outreach and managing that population so that they never have that disease," she said.

That take-charge approach is a hallmark of value-based care as executed at Kaiser Permanente, Dr. Ansari said in a recent episode of “AMA Update.”

An AMA survey found that 86% of physicians reported a portion of their revenue from fee for service, and nearly 60% work in a practice that’s part of an accountable care organization.

The move toward value-based care is a positive trend, said Dr. Ansari.

“Value-based care is really a care-delivery system that rewards for patient outcomes and quality of care, managing a population rather than transactional care,” she said. “It's more continuous care, population health and being rewarded for patients who live longer, healthier lives, as opposed to more siloed, transactional care that's more episodic.”

To illustrate how value-based care works best, Dr. Ansari reflected on the first few years of the COVID-19 pandemic. Most people did not see physicians for preventive care at the beginning of the pandemic, and that led to a backlog of patients who needed checkups.

The Permanente Medical Group saw that happen with mammograms. Rather than try to squeeze in as many patients as possible when they called to make appointments, the health system prioritized patients who needed the care most.

To do that, The Permanente Medical Group used augmented intelligence (AI) —often called artificial intelligence—to analyze more than 1,000 data points to predict what patients were more likely to have cancer.

"AI predicted better than traditional risk factors by 60%," Dr. Ansari said.

AI is not a requirement for value-based care, but a technology infrastructure is important so that health systems can leverage data to focus on prevention.

The push for value-based care is gaining momentum. Dr. Ansari applauded the push to implement a more proactive approach to patient care; it's a change she said is long overdue.

"We've been living in a system that rewards disease instead of rewards prevention," Dr. Ansari said. "Part of the future is really trying to shift that mindset into doing the things that we set out to do as medical students, which is to really help patients live a healthy life."

Learn more with the AMA about value-based insurance design (PDF) and advancing value-based care with alternative payment models in Medicare.

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