Dr L. Patrick James: Incentives Must Be Aligned for Value-Based Care Arrangements

Incentives must be aligned between payers and providers to transition to value-based care and physicians must have the best access to information to make the right decisions in these value-based arrangements, explains L. Patrick James, MD, chief clinical officer for health plans and policy, medical affairs, for Quest Diagnostics

Transcript (slightly modified)

What is the biggest barrier to advance value-based care right now?

There is a couple of things; one, is we have to have incentives aligned. I think value-based arrangements are trying to get that solved so everyone is aligned in terms of incentives and how they’re rewarded in these activities. The other thing is the tools available and we talk about that in the study that we’ve done with Inovalon; that physicians, even though they might have very sufficient electronic medical records, sometimes it’s difficult to find the right information when you’re with a patient to make the right decision to execute well on value-based arrangements.

How can we better align incentives between payers and providers to speed up the transition to value-based care?

I think the provider-payer distinction is blurring. I know a number of larger health systems are also getting into health plans and some health plans are acquiring provider practices. So, that distinction, I don’t think is as black and white as it was maybe 10 years ago. There is a convergence of those activities.

Secondarily, I think there are forces driving better alignment and collaboration. I think we all understand that we have to get there together, and rolling up our sleeves, and finding commonalities, and getting those Venn diagrams identified where there is overlap and we can drive towards starting to get some successes under our belt.

How can the healthcare industry ensure that data is more actionable at the point of care?

Well that’s the Rosetta Stone, that’s really what we need to do. When we partnered with Inovalon, for example in data diagnostics; we brought Quest capabilities, in the laboratory area, our data. But, probably most importantly, our pipeline into physicians and interfaces with the electronic health record.

If you don’t have the ability to get the data into the system that the physician is using at the time they are seeing the patient, or a little bit before, it’s going to be hard to make that information usable. It has to be relevant, it has to be beneficial to the physician and patient, it has to be real time, and it has to be very quick. Otherwise, physicians aren’t going to use it.