Dr Peter Aran on the Different Ways of Approaching Value-Based Care

There are 3 different areas of healthcare that all face different challenges in implementing population health and adopting new reimbursement models, explained Peter Aran, MD, medical director of Population Health Management at Blue Cross Blue Shield of Oklahoma.

Transcript

What are the differences in adopting new reimbursement models within a healthcare system versus a community practice?

One of the biggest challenges that is going to keep getting bigger, is that as health systems buy private practices, health systems are coming at value-based care from a different perspective than a private practice may come at value-based care. In some markets fee-for-service is still the king, and some of us believe that fee-for-service will always play some role in healthcare delivery, but it’s going to have a diminishing role over time. So when CMS is talking about 50%, 60%, 70%, 80% value-based care reimbursements for quality care reimbursed in this way in the next 2 or 3 years, we think that maybe it won’t be quite that much, but that will happen over time.

And so health systems in some markets are still fee-for-service based, and we have to work with that. Private groups are easier to work with in the sense that aspects of their business plan, such as admissions or readmissions or on-site radiologic studies, or on-site laboratory studies, which oftentimes are more expensive than off-site studies, that isn’t in their business models. So it’s easier to work with that part of the whole total cost picture. So that’s one aspect.

And then the third group that I’m going to mention, because it’s a fascinating challenges is you have employed physicians in large health systems, and you have independent physicians, oftentimes in small-town America, then you have this third sphere, which is academic medicine, and how do we then diagram these 3 spheres of healthcare. That’s the challenge that we all have. And how do we train medical students, residents, and fellows on population health? That’s one of my top goals.