Dr. Parodi shares 3 keys to driving real change in health care

Achieving true success in value-based care demands a transformative approach that goes far beyond simply changing how physicians and health care organizations are reimbursed. To drive real change in health care requires focus on 3 foundational principles that elevate patient outcomes and system efficiency, said Stephen Parodi, MD, executive vice president with The Permanente Federation, at Reuters Events’ recent Total Health USA conference.

“You have to have simplicity, you have to have the impact factor, and you have to have prior authorization,” he said on the “Future-Proofing healthcare: The Path to Value-based Systems of Care” panel.

In value-based care, “impact factor” refers to the combined positive or negative effects of care models on patient outcomes, quality, and cost. This measure focuses on aspects like reduced hospital admissions, better patient outcomes, lower costs, and improved quality of care, rather than the number of services provided. The success of a value-based care program like Permanente Medicine is determined by how effectively it improves these results, often using a formula that weighs quality by total cost of patient care over time, as outlined by the American Medical Association.

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Managing chronic conditions key for value-based care

Dr. Parodi added that focusing on cardiovascular disease measures, cancer screenings, and mental health disorders would have the greatest impact on improving outcomes across a broad spectrum of people.

“If you address those 3 things, you’re going to impact most of the large population-based issues that the nation is facing,” he said.

He added that what matters most from a patient experience perspective are care access and total cost of care. “You do a good job with all those things, and that’s what value-based care is,” Dr. Parodi said.

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Optimizing team efficiency and patient outcomes

In the face of evolving health care demands — especially with a growing older adult population and a surge in chronic illnesses — value-based care organizations must also continuously improve care delivery and coordination to optimize outcomes, efficiency, and cost-effectiveness. For example, Kaiser Permanente of Northern California used an artificial intelligence algorithm to  predict and stratify risk for patients with chronic, complex medical, social and/or mental health conditions. The algorithm identified approximately 8,000 patients who were at high risk for future emergency department visits and/or hospitalization.

Each care team focused on these patients has a physician, nurse, social worker, pharmacist, and a care manager. If the algorithm flags a mental health need, the care team can make an appropriate referral. A project team was then able to pinpoint the specific reasons each patient was at risk — whether medical, pharmaceutical, social, or mental health — and alert only the relevant specialist on each team, such as a pharmacist for pharmacy-related issues.

Dr. Parodi noted that the project reduced hospitalizations and emergency visits, saving about $1.5 million per team. Previously, care teams oversaw about 200 patients each. Now, each team manages about 1,500 patients because each care team member responds only to specific issues that require their attention.

“What’s interesting is we’ve been able to increase the efficiency of the care team. And you might ask, ‘Okay are the teams upset because they’re having to look after more patients?’ And the answer is that we actually have more satisfied teams because they’re able to resolve the problem.”