The Executive Suite: Four strategies to advance value-based care

Amid rapid health care industry consolidation, a challenging cost environment, and increasing patient needs and expectations, only truly nimble health care organizations will survive and thrive.

Medical groups focused on prepaid, value-based care are better positioned to innovate, develop, and invest in technologies to respond to patient needs and market dynamics. For example, value-based organizations that bet big on telehealth and remote patient monitoring technologies prior to 2019 were able to continue seeing patients remotely during the COVID-19 pandemic. In contrast, fee-for-service health care systems — which are paid per office visit, treatment, and test — struggled. As a result, a movement is now underway in health care, from volume of care to value of care.

Shifting to value-based care

Value-based care organizations prioritize prevention through early detection and proactive treatment of health issues. Physicians and care teams work together to manage the overall health of individuals and populations. Financial incentives are tied to keeping the patients and communities they serve healthy. Every interaction, from telehealth, including video visits, to in-person visits, is an opportunity to address patient needs, including access to healthy foods and community-based resources. The guiding principle is evidence-based, quality care that is cost-efficient while maintaining convenience and affordability to patients.

Last year, the U.S. Centers for Medicare & Medicaid Innovation issued an ambitious goal to shift 100% of Medicare beneficiaries into an accountable care insurance plan by 2030. Given that the number of Americans 65 years and older is projected to increase more than 40% to 82 million by 2050, that announcement signals a massive shift in strategy where a huge swath of Americans will receive some form of health care services tied to value arrangements.

Innovating to drive value

Value-based care is the future of medicine, and everyone is trying to get it right. Based on our nearly 80 years of experience, here are four innovative strategies physician leaders can adopt to advance value-based care.Embrace artificial intelligence (AI) to help physicians with administrative tasks and improve quality care. With AI, physicians can get comprehensive insights into patient health, experience, and health care utilization at the individual and population levels. For example, at Kaiser Permanente Northern California, computer vision algorithms were used to identify patients at risk for breast cancer quicker and more efficiently. Also, we are using new ambient AI scribe technology to help physicians write clinical visit notes, enabling more face time with patients and reducing physician time spent after-hours on administrative tasks.
Focus on optimal wellness by delivering the right care in the right venue, including care-at-home for an aging population. Value-based care models allow organizations to invest in people, technology, and services that support team-based care. We currently provide at-home services in six regions across the country, doubling our commitment to this care model from 2022. Patients have told us they love recovering at home. As of April 2024, more than 320 hospitals across 133 health systems in 37 states are authorized by the Centers for Medicare & Medicaid Services to offer acute hospital at home under a waiver expiring at the end of this year. To make these programs scalable, we support a five-year waiver extension. We also want these services to be included in traditional Medicare coverage so health systems can sustainably care for the increased number of older adults.
Solve the shortage of primary care physicians. Primary care physicians are the first line of defense against illness or injury. However, 30% of Americans currently do not have a primary care physician due to a shortage. Policymakers should consider measures that bring a new generation of talented and diverse physicians into medicine. Increasing the number of graduate medical education slots — proposed by the Resident Physician Shortage Reduction Act — would be a good start. Additional solutions include immigration policy reforms that remove obstacles for foreign-born physicians and significant investment in medical education and training. Permanente medical groups participate in community-based programs that spark interest in medicine among diverse students at a young age. They include Kaiser Permanente Southern California’s Hippocrates Circle Program and Kaiser Permanente Northern California’s Prep Medico and Medical Scholar’s Pathway.
Identify and address health disparities and emphasize prevention. Value-based care focuses on quality outcomes. This encourages physicians to provide equitable care by addressing the root causes of health inequities. This is preventive medicine at its best. Through an effort led by our National Equity, Inclusion, and Diversity and Quality departments, our outcomes reporting has brought greater visibility to health disparities and their impact on patients. We use insights from this reporting to create comprehensive plans to address disparities. For example, research published in The New England Journal of Medicine showed that a decade of enhanced screening for colorectal cancer with fecal immunochemical tests (FIT) essentially eliminated disparities between Black and White Kaiser Permanente members in Northern California and that organized screening improves colorectal cancer outcomes for all our members.

Innovation thrives in prepaid, value-based care systems, which have successfully demonstrated their ability to adapt to major market disruptions. During this time of rapid change and increasing uncertainty, health care organizations will need to shift to value-based care to better serve patients and remain competitive.