Bridging the Gaps: Dr. John Rodis Says Improving Support Between Visits Is a Priority for Value-Based OB Care

Dr. John Rodis is the founder of Arista Health, a healthcare consultancy that helps hospitals and health systems improve quality and patient experience. He is a former practicing OB with 35 years of clinical experience specializing in prenatal diagnosis and management of  high-risk pregnancies, such as multiples, and mothers with chronic conditions such as diabetes, heart disease and kidney disease. He has also served as a residency program director, department chairman,  chief medical officer and hospital president. Wildflower recently interviewed Dr. Rodis on the promise of value-based care within the OB setting and how we move forward.

What is the promise of value-based care within the OB setting?

Pregnancy is the only time in a doctor’s life when you interact with mostly healthy patients nearly ten times in a single year. We miss out on a lot of opportunities because these visits are very short interactions where we’re checking blood pressures and heartbeats, running some tests and then the appointment is over. We could be educating patients on long-term impacts from lifestyle choices and help prevent chronic disease. We don’t really have, or make, the time to discuss healthy diet, quitting smoking or alcohol use. We spend very little time on prevention. It’s all focused on diagnosis and treatment. 

Approximately 50 percent of patients who develop gestational diabetes during pregnancy will go on to develop Type 2 Diabetes and hypertension, and eventually heart disease, kidney disease and other chronic conditions. When you have a patient who has gestational diabetes, that’s the time to have conversations about the long term consequences. We just don’t spend enough time talking about future implications. We’re too focused on the short term instead. 

The promise of value based care in the OB setting is that we can have a continual interface and relationship building during pregnancy. We can be more proactive. We can continue to engage patients after the birth of their babies and support and encourage healthy decisions for them and their families for a lifetime.

Is it safe to say there is still a lot of stakeholder education needed to change the relationship dynamics between patients and providers?

The average consumer has no idea what questions to ask or how to evaluate where they should seek care. An expectant mom isn’t likely thinking about the possibility of pregnancy complications or issues with her newborn and which hospital would really be able to best equipped to take care of them. Patients don’t appreciate that the chance of dying or developing a preventable, serious hospital-acquired condition in a D rated hospital is twice as likely as a hospital with an A rating. Physicians don’t know much about value-based care either. They don’t know how many stars the hospital they work at has with CMS or what the 57 variables that go into the star ratings are. They often don’t know what their own complication rate from C-sections is or how they compare with peers.

What role does technology play in advancing value-based care and improving the patient experience?

There’s not time to deliver all the necessary education within the confines of the office visit, even if we extend the duration of it. You need a technology platform that offers support between visits, while creating an environment that is more comfortable for patients than the doctor’s office or the waiting room. With digital health offerings, you can create learning opportunities at home. Patients can review the information together with a spouse or family member. They aren’t forced to process a lot of information during a short doctor’s visit when they already are probably anxious or uncomfortable. It just creates a better experience for patients. Bottom line, we need to learn how to interact with patients between visits. Technology can support that.

How do we fuel more adoption of value-based care programs?

Value-based care will be driven by employers. After all, they are the ones with the most at stake for keeping individuals healthy. They invest in recruitment, training and pay the healthcare costs of employees for 20 or 30 years. I honestly don’t think you can manage value-based care through doctors, and it’s too complicated to engage patients directly. It has to be plan design through employers. They can steer their employees to receive care from providers and the hospital with fewer complications through education and incentives, such as covering more of the out-of-pocket costs. We can also reward providers who deliver better experiences and outcomes. We can have better transparency for all stakeholders. But it starts with plan design.

Can you provide an example of how value-based design can reduce variability in quality? 
 
There is tremendous variability in quality from one hospital to the next. When I became a department Chair, I would start my day “rounding” on the Labor & Delivery Unit.  When looking at ‘the board’ on the OB floor—the white board in which all the patients were listed (deidentified of course) along with their age, how many pregnancies they had, how far along their pregnancy was in weeks and how far dilated their cervix was—I noticed that many of the patients were first time moms, a few weeks away from their due date and that their cervices were not dilated very much, often less than 1cm dilated. When I trained, we couldn’t admit a patient who was less than three centimeters dilated. This facility had a C-section rate of 40 percent, but just 70 miles up the road a comparable hospital had a rate of 20 percent. Why the discrepancy? 

The patients in this specific area wanted to pick the time they had their babies. They were coming in at the first sign of pain, and many of them were being induced before carrying to full term. Instead of waiting for natural labor, they were spending two days in the hospital to be induced and had longer recovery times because of an ultimate C-section. That wasn’t the best outcome for most of these women. To change the behavior, it required education for the consumer and financial penalties and quality incentives for the physicians. Both were needed.

Can you leave us with one specific key to success for value-based care design?

You can’t address it in compartmentalized way. You can’t tell OBs to keep the cost down. Not everything is under their control. It takes the hospital, patient and physician working together to make a difference. You have to build all of the desired outcomes into plan design. That’s how you get this done. 

For more insights from this interview series, as well as additional tools and best practices to accelerate your journey in virtual and value-based care, please visit www..valuebasedobcare.com.