Why physician-led, value-based care leads to better outcomes

During a recent Becker’s “Leadership Unscripted” podcast, Maria Ansari, MD, FACC, co-CEO of The Permanente Federation, discussed how her discovery of Kaiser Permanente’s value-based care model changed her career path.

“I had planned to spend my whole life in academics, doing research, training folks, and practicing medicine,” she said. But while conducting research at Kaiser Permanente — “because that is where a lot of medical informatics is and a lot of patients are” — she had a light bulb moment that changed her professional journey.

“I learned that if you’re a Kaiser Permanente member, and you live in Northern California, you’re about 30% less likely to die of a heart attack or stroke,” she said.

She reflected on how physicians and clinicians working in clinical practices outside of Kaiser Permanente are paid for every individual service rendered – such as tests, visits or procedures, rather than a flat fee. In contrast, Kaiser Permanente’s value-based care approach ties payments to patient health outcomes and quality, rather than the volume of services delivered.  As a result, Permanente Medical Group physicians and clinicians emphasize disease prevention and physician-led decision-making.

With this realization, Dr. Ansari said, “I left academic medicine and I joined Kaiser Permanente.” Now, 2 decades later, she hasn’t looked back.

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Addressing America’s health challenges

As a result of physician ownership of The Permanente Medical Group in Northern California, physicians generally enjoy a high degree of clinical autonomy over their practice. However, this autonomy is balanced with strong group accountability and adherence to evidence-based medicine. Another compelling feature of the Kaiser Permanente model is “the integration with a hospital and health plan system, so that all our incentives are aligned for the best interest of the patient,” she said.

Dr. Ansari added that health care systems across the country need to shift to value-based models to address increasing U.S. health care costs as well as poorer health outcomes compared to other high-income, wealthy nations. According to the National Institutes of Health, Americans experience lower life expectancy and higher rates of chronic disease, such as obesity and diabetes, compared to citizens of other peer nations.

“Within the older population, we’re seeing most patients over 65 with 2 or 3 chronic conditions,” she said, adding that even the young and healthy are not so healthy. “Disease burden is up, costs are up, utilization is up. And it doesn’t seem like there’s an end in sight.”

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Collaboration drives quality care, better outcomes

She said Kaiser Permanente’s value-based care system doesn’t make money by doing more, but by doing better — focusing on quality, prevention, and efficiency.

“We actually have the most affordable health care with the best outcomes,” she said. “And our patients live on average about five years longer, with 30% less heart attacks and 25% less cancer [than others in their communities].”

Dr. Ansari attributes such successes to collaboration across the system.

“Because all of our colleagues work together, if you come into the dermatologist for a rash or psoriasis, the team there is going to ask you, have you had your colon cancer screening? Have you had your flu shot? We’re all working together in a collaborative way.”

Dr. Ansari is eager to see more health care organizations embrace value-based care, and to that end, Kaiser Permanente is taking its evidence-based approaches and best practices to Federally Qualified Health Centers and other county hospitals.

“The next step is to improve the health care in communities beyond the Kaiser Permanente system and its membership,” she said.

To hear the full interview, visit Becker’s Healthcare Podcast.