Adjusting to Value-Based Care

MIAMI BEACH—Adjusting to the new nationwide emphasis on value-based medicine, especially in large academic medical centers, is proving to be a lengthy—and painful—ordeal, but physician leaders offered guidance at the Triological Society Combined Sections Meeting, citing experiences at their own centers as examples.

They described a dramatic flattening and simplifying of their systems to promote the alignment of incentives, a deep dive into the financial minutiae of head and neck cancer in search of more cost-effective care, and new ways to improve value in pediatric otolaryngology.

Department Mergers

Douglas Girod, MD, executive vice president at the University of Kansas Medical Center in Kansas City, offered a reminder that the driver of the emphasis on value is the Affordable Care Act of 2010, which includes five major aims: expansion of coverage through Medicaid and exchanges; insurance market reform with required coverage; payment and delivery reform; quality and safety improvement; and better control of costs.

In a nutshell, Dr. Girod said, “You need to increase the patient experience, you need to improve the quality, and you need to lower the cost.”

Increasing the focus on wellness, consistently providing cost-effective care, and rewarding safety, quality, and innovation means aligning incentives, which will take a very collaborative approach to do, since this focus covers such a broad spectrum, he added.

At academic medical centers, it is particularly difficult due to the tradition of a “federated” structure and “limited central governance,” he said. But these institutions need to be integrated organizationally, clinically, financially, and with regard to information and engagement in community health, Dr. Girod said. “Trying to create integration through this environment is not a simple assignment,” he added.

At the University of Kansas, a $2 billion per year, 1,800-employee academic medical center, the previous model was that each of the 18 departments was its own 501c3 corporation with its own board of directors, with physicians employed by the departments. The hospital had its own board of directors. There were 19 different benefit plans in the mix, Dr. Girod said. “There were literally hundreds of contacts flowing between all of these different entities,” he said.

Now, after a four-year restructuring process, all of the departments have been collapsed into a single practice plan that is merged with the hospital on a financial basis. Dr. Girod said it is still a physician-run practice, with physician leaders placed throughout the system to help guide the continued evolution. “We’ve gotten it done on paper,” he said. “We’ve got to do it in practice.”

Streamlined Care

Myles Pensak, MD, CEO of the faculty practice group University of Cincinnati Physicians, described the efforts to improve value-based medicine at his center. There, the physician practice plan is completely independent, with physicians leased to the University of Cincinnati’s health system. Over the last several years, 17 departments, which were