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Physician Consultant: Value-Based Care Will Reach a Tipping Point

October 27, 2014
by Gabriel Perna
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Tonya Edwards, M.D.

In the latest Healthcare Informatics podcast, Tonya Edwards, M.D., physician advisor at Impact Advisors, shares her thoughts on the early population health management initiatives with Senior Editor, Gabriel Perna.

Dr. Edwards explains why primary care physicians and doctor-led accountable care organizations (ACOs) are doing better with value-based reimbursement than their hospital counterparts. “It’s possible that physician-led ACOs tend to be more nimble in execution because there is less risk than there is for hospitals,” she says. The other main takeaway is that “investments into IT” are essential for success.

She then talks about why the CMS Pioneer program is like taking an honors class. She says that many organizations that struggled with the program, and some dropped out, ultimately weren’t as ready as they thought they were.

The conversation then shifts to the return-on-investment (ROI) of the health IT systems needed to make population health work. Edwards says that while some healthcare organizations have had problems with the ROI of these systems, many have not and the overall numbers show a positive trend in terms of healthcare cost savings and improvements in quality.

“Nearly all participants of the CMS MSSP program had improvements in quality in year one, particularly in population of increased risk. What that demonstrates is we’re clearly learning how to take care of patients across a continuum and some of us are better than others at saving money while doing so,” says Edwards

Ultimately, the IT systems will prove to be good investments for those shifting to value-based care, she concludes, “How long it will take to achieve that ROI varies from institution to institution.”

At the end of the podcast, Edwards gives her prediction on the future of population health management in the next five years. “We’re in for a ride…but organizations are going to stand with one foot in this world and one foot in fee-based care for a few years. Gradually though, the percentage of value-based care will reach a tipping point.”

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