Motive Medical Intelligence founder and CEO Jeanne Cohen
Photo: Motive Medical Intelligence
Hospitals and health systems must take an abundance of measurements to succeed in value-based care.
Jeanne Cohen believes healthcare leaders are overlooking the key to value-based care success: physician-level measurement.
"Because physician decisions control quality and cost, visibility into that decision making is essential to VBC success," she said.
Cohen is founder and CEO of Motive Medical Intelligence, a healthcare data and analytics company focused on physician-level performance and value-based care.
We spoke with her recently to get a deep dive into individual physician decision making, how the first phase of VBC resulted in limited progress, transparent and evidence-based analytics, and realizing VBC's goal of better care at lower cost.
Q. You've said that one of the reasons value-based care has failed to meet its promise is that it hasn't given sufficient attention to one of the most impactful drivers of cost and quality – individual physician decision making. While there has been broad adoption of population metrics, these alone are not sufficient to drive the improvements in quality and cost that are the promise of VBC.
A. When VBC was first introduced, the focus was necessarily on building the technology infrastructure, developing the required payment models, and creating the population health frameworks that would drive better care and lower cost.
Structuring programs around quality improvements in the management of high-cost patient populations – such as those with diabetes or chronic heart disease – was both practical and essential. These are measurable conditions with clear baselines and outcomes that could demonstrate tangible improvement.
However, while this population-level focus was a necessary first step, it is not sufficient for realizing the full potential of VBC to improve quality and outcomes and lower cost. Because physician decisions control quality and cost, visibility into that decision making is essential to VBC success.
Population-level metrics are useful for identifying broad trends but do not provide information about individual physician performance. Value-based care means providing the right treatment to the right patient at the right time, every time.
How is that possible if physician decision making and physician performance are not known and measured? Averages hide meaningful differences in practice.
Without visibility into how physician decisions impact quality and cost, even the highest-quality physicians are flying blind. If we want to close the gap between VBC's potential vision and its reality, we must look directly at physician decision making.
That's where the levers for true improvement lie. When clinicians can see their own decision-making data and have the requisite business frameworks to support them, they will make changes in their care delivery to impact patient care and cost.
Q. You also noted that the first phase of VBC focused on changing payment structures – such as shifting from fee-for-service to capitation – without developing the physician performance insights essential to the success of these payment structures. How did that happen and what have been the results?
A. The first phase decade of VBC reform revolved around new payment models with primary care as the care delivery hub. The assumption was that changing financial incentives – from rewarding activity to rewarding outcomes – would result in better care.
Primary care as the hub was also to be the gateway to more expensive specialty care. We invested billions in contracts, risk models and shared-savings programs – but failed to pair those structural changes with performance tools that measure how individual physician decisions impact quality and cost.
The consequence has been more than a decade of mixed results, but this should be seen as an opportunity rather than a shortfall. Some primary care models and accountable care organizations have been successful in improving care and lowering costs, but system-wide progress has been uneven and incremental.
The next phase of VBC offers the chance to change that. Financial incentives alone can't drive sustained behavioral change. When physicians don't see clear, credible data about their own practice patterns, they don't change their practice behaviors.
True accountability and real opportunity require measurement that connects payment to performance in ways clinicians can see, trust and act upon. This is what our Practicing Wisely brings: credible, transparent, evidence-based measures across 20 specialties and primary care, as well as pediatrics.
Q. To combat these problems, you argue that real VBC success requires transparent, evidence-based analytics that show physicians how their specific decisions affect costs and outcomes. How do physician-level analytics solve the issues you describe?
A. Physicians are inherently data-driven, but they need data that is transparent, explainable and relevant to their own patients. All too often, today's performance dashboards rely on "black box" scoring algorithms that generate ratings without sharing context or rationale.
Clinicians receive a number or percentile ranking with little insight into how the measure was derived, which breeds skepticism and friction rather than engagement.
In contrast, physician-level analytics grounded in peer-reviewed evidence illuminate cause and effect. They can demonstrate, for instance, that a three-week radiation regimen yields the same outcome as a five-week course, helping physicians align practice with the latest science while reducing cost and burden for patients.
When data is presented to physicians in a way that is clear, traceable and linked directly to evidence, they respond. We've seen it time and again and often – it's the very first time they have seen such data. They have their a-ha moment and start to change practice behaviors and improve.
Once more, they can benchmark themselves against peers, audit their decisions and take ownership of improvement. It shifts the culture from one of compliance to one of professional curiosity, friendly competition and change.
Transparent clinical analytics transform measurement from a policing mechanism into a learning tool, empowering clinicians to refine care in real time. As physicians engage, organizations gain the feedback loops that population-level averages can never provide – and genuine value-based performance is able to take shape.
Q. Finally, you've said that until the healthcare system measures physicians individually, it will not expose low-value practices, deliver better care, or realize VBC's goal of better outcomes at lower cost. How does the industry reach that ultimate goal?
A. The path forward is both simple and bold: Integrate physician performance measurement information critical to all stakeholders – physicians, payers and patients – into the VBC model.
Physicians want to deliver the best care possible, but they need actionable data about their own decisions and the things they control in their own practices to do so, not just abstract scores.
Transparent, evidence-driven clinical analytics give them the feedback necessary to improve their care and maintain the trust of both payers and patients. And that is the value in value-based care.
Follow Bill's health IT coverage on LinkedIn: Bill Siwicki
Email him: bsiwicki@himss.org
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