Dr. Davidoff on how value-based specialty care rewards quality over quantity

Ramin Davidoff, MD, co-CEO of The Permanente Federation, recently spoke about how Kaiser Permanente’s integrated, fully prepaid, value-based care model emphasizes and rewards the quality of specialty care and primary care rather than the volume of services delivered. As a result, all Permanente physicians can focus on disease prevention, chronic disease management, and efficient care delivery.

“Specialists fit beautifully into this prepaid model by focusing on outcomes with specific incentives that provide higher and higher quality care,” Dr. Davidoff told moderator Don Crane, who is the former president and CEO of America’s Physician Groups, at the Virtual First National Specialty Care Transformation Summit.

With its focus on high-quality care and outcomes, Kaiser Permanente’s commercial and Medicare plans were rated highest or tied for highest for overall treatment, prevention, equity and patient experience in every geographic region they serve, according to the 2024 National Committee for Quality Assurance report.

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In Kaiser Permanente’s integrated, physician-led care structure, primary care physicians typically serve as quarterbacks who lead and direct care in direct collaboration with specialists. They evaluate patients, close care gaps such as missed mammograms or cancer screenings, and consult with specialists for expert advice on how to best meet a patient’s specific needs. Primary care physicians make their referral decisions based on a combination of collaboration, the most up-to-date research, knowledge, clinical expertise, and the patient’s values.

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“If a primary care physician sees a patient with a renal cyst that was found incidentally on an ultrasound of the abdomen … that primary care physician is able to make a decision about whether that patient needs to see a urologist or a nephrologist,” said Dr. Davidoff. “We think it’s important for that touchpoint with the primary physician to occur for the appropriate referral to the correct specialist.”

Both primary and specialty care physicians make their decisions with support from the patient’s electronic health record (EHR), which provides a comprehensive view of a patient’s medical history. The EHR also prompts physicians and care teams to look for care gaps and makes it easy to order screenings or other laboratory tests. This level of integrated care and technology helped Kaiser Permanente achieve breast and colorectal cancer screening rates that are among the nation’s best.

“We depend on our specialists to help close care gaps, too,” Dr. Davidoff said. “So as a urologist, I can see in the electronic medical record the prompts that tell me a patient is due for a mammogram, a colonoscopy, or some other care need. And I talk to the patient about the need to get that screening.”

In addition, a “doctor advice” function allows a primary care physician to send a message to a specialist about a patient and ask them whether the patient needs a referral. If a referral is needed, the primary care physician can also ask the specialist whether any laboratory tests or screenings are required ahead of the patient’s visit and order those tests or screenings if necessary.

“Our model, supported by technology, allows for a much more coordinated and streamlined approach to care,” Dr. Davidoff said.

He added that as the U.S. population ages, multiple specialties will need to coordinate to manage the chronic and acute diseases that typically accompany aging, including chronic obstructive pulmonary disease, diabetes, heart disease, hypertension, and cancer.

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“We believe that by being more efficient, by producing high quality care and focusing on value — value to the patient — that we ultimately reduce the cost of care,” Dr. Davidoff said. “And that truly is the answer for health care in the United States.”

Note: You can view the full fireside chat video here.