The Missing Ingredient in Value-Based Care: Dr. Jan Berger Discusses the Need for Re-engaging Trust
Dr. Jan Berger is a tri-sector healthcare executive with proven results in private, public and government services over the last 30 years. In 2009, Jan founded Health Intelligence Partners, a global health care consultancy. She previously served as Senior Vice President, Chief Clinical Officer and Innovation Officer for CVS Health/Caremark. Berger is also the author of the forthcoming book “Re-engaging Trust: The Missing Ingredient to Fixing Healthcare.” Wildflower recently interviewed Dr. Berger on the importance of trust, collaboration and communication in value-based care.
There are a lot of moving parts in value-based care. Where do we begin the discussion?
I started my career in a staff model HMO, which was an earlier iteration of value-based care. A lot of what was good about our efforts during that time has been resurrected in recent models. Just like the initial HMO days, it’s important to understand that if you’ve seen one value-based care program, you’ve seen one. There are many variations or value-based care. It can be upside incentives, full risk, global full risk, with or without medications and so on. The most important place to start any conversation around value-based care is by clearly defining what you mean by the term.
How do we foster more collaboration among stakeholders?
I’m cynical, because I don’t believe the four stakeholders - patients, payers, providers, policy – have ever sat down and had an honest conversation around value-based care. We need to change that if we’re going to be successful.
I was sitting in a board meeting recently, and we were talking about value-based care. I asked the clinical lead for the organization if they had brought all the payers in the region together to see if they could encourage synergy among quality metrics across their market. The first person in the room to respond said it wouldn’t work. But we have seen it work, especially when it is mandated or driven by employer demand. Opening the door to effective value-based care comes from collaboration. Employers hold the key to unlock that door and bring everyone together.
How do we find more alignment among stakeholders?
Physicians come to work every morning believing they are delivering the very best care. They don’t necessarily understand what it means when you say value-based care. Meanwhile, payers don’t always understand how medical groups run their business. Most people don’t realize because of tax laws, most medical groups don’t have a rainy day fund. Their margins don’t stay in the business. How will they finance efforts to participate in value based care? We have to answer that question.
If we all agree that we want to do the best things we can do for patients, the Venn diagram becomes our friend. Find a few metrics that everyone can agree on, and start there. Start from a place of trust, and then build on success. This is critical because trust doesn’t really exist between payers and providers today.
What should OB providers consider before participating in value-based programs?
OBs are not trained to deliver value-based care. If it’s not presented correctly, doctors will move forward with value-based initiatives for financial reasons, but they won’t fully understand what is required to succeed. They aren’t trained in a team approach, in leveraging data for population health.
Providers should be thoughtful about how far they want to go. Will you focus on the OB episode only, or women’s health as a whole? Are you taking risk just on maternity outcomes, or are you signing up for total cost of care and acting as the primary care doctor for your patients.
What role does the patient play in this process?
At the end of the day, it’s about the consumer. We are not in the era of consumer health. We’re talking about it, but we aren’t doing it. Where is the patient in all this? Where is the patient’s voice? Have you asked patients in your demographic group what they want and how they would like to be supported during their pregnancies? I don’t think you’ll find many OBs, or many payers, who have asked this question. That’s a problem, because the patient can blow this entire value based equation up. Without the patient, VBC is a financial vehicle, not an outcomes vehicle. Quite frankly, there are a lot of blunt instruments we can use to simply reduce healthcare costs, if that’s what we’re after. No one will be happy, but it can be done and is easier than wrestling with value-based care.
Can you imagine patients being excited about a healthcare encounter the way they are when a Zappos box lands at their front door? Zappos is famously known for going above and beyond with its customer service to delight its patrons. Healthcare is the very last industry to ask the end consumer, “What is it that you need?”
The digital health space has been exploding with investment and innovation over the past several years. Do you think technology is the key to unlocking value-based care?
Technology does not hug you when you’re scared or when you’re sick. Everyone thinks tech will solve everything, but it can’t. A mixture of high touch and high tech must be the answer. Right now, we are enamored with technology. Yes, technology plays an important role and offers enormous opportunities. But you have to pair it with human touch.
There are information gaps and emotional traps that can’t be solved by technology. Here’s a perfect example. A man finds out he has type 2 diabetes. He starts crying after the doctor tells him he has stop eating ice cream. Initially, the care team thinks the patient’s emotional state is being driven by a fear of needles or getting his blood tested. But it turns out that he was afraid his wife would divorce him because they could no longer continue a very special tradition of getting ice cream together. You need human intervention to help this patient. You can’t throw technology at this problem.
Another major trend is an increasing interest in social determinants of health. Why haven’t we seen more substantive progress in this area?
SDOH is becoming a buzzword. It’s absolutely a critical part of the discussion, but most people are boiling the ocean with it. There are very real life issues impacting health outcomes in maternity that have little to do with economics. To address them, we should be more specific and concrete in what we’re trying to accomplish. Too many people are just using the SDOH label without having substance behind the solutions they offer.
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.