What it Takes to Change to a Genuine Value-based Practice Model

Answers from a visionary practice leader and this year's AAOS president.

CORRelations staff regularly visits with leaders at efficient practices to learn about the innovations, modifications, or upgrades that have made big differences.

This week, CORRelations spoke with Kevin Bozic, MD, MBA, chair of the Department of Surgery and Perioperative Care at Dell Medical School at the University of Texas at Austin. Although an academic practice, his is one that has engaged in across-the-board innovations that add value to care, and many of his changes would generalize well to other practice settings. In addition, Dr. Bozic is the president of the AAOS this year, so his perspective is one we might all benefit from.

CORRelations: What’s been the biggest game-changer for your practice lately?

Kevin Bozic, MD, MBA: We transitioned from an orthopaedic surgery practice to a musculoskeletal medical home earlier in my tenure at Dell. The focus on musculoskeletal health rather than orthopaedic surgery has created opportunities on so many levels, not the least of which is that by organizing care around a condition (musculoskeletal disease) rather than physician specialty (orthopaedic surgery), it forced us to think about the skill sets and competencies needed to manage musculoskeletal disease effectively, which include expertise in patient activation, behavioral health, nutrition, wellness, and lifestyle modification, to name a few. 

 CORRelations: Why are you so excited about it? 

Dr. Bozic: Being surrounded by experts in all aspects of musculoskeletal health has had a tremendously positive impact on our patients’ outcomes and overall experience. A happy surprise was that this model also improved clinician wellness and retention. Under this model, we’ve had less than 5% faculty/staff turnover, which is amazing considering this period overlapped both the COVID pandemic as well as “the great resignation.”

The secret is that all of our team members are functioning at the top of their licenses. Advanced practice providers (nurse practitioners, physician assistants, chiropractors) are front-line clinicians treating their own patients rather than “extending” physicians; physical therapists are incorporated into the clinical workflow and see patients in real-time with the rest of the clinical team; behavioral health-trained social workers are helping patients manage the mental health challenges associated with chronic musculoskeletal conditions; and dieticians are assisting patients with weight loss and lifestyle modifications, thus freeing up the orthopaedic surgeons to focus on what they do best — orthopaedic surgery — rather than trying to be mental health professionals and lifestyle coaches.

 CORRelations: How has it worked out?

Dr. Bozic:
 As you'd expect, developing an entirely new clinical model that bucks the trends of traditional practice has been a journey with many ups and downs, and lots of lessons learned. A few that come to mind are:

The incentives in the current predominant payment model in U.S. healthcare fee-for-service are not aligned with value. To sustain a value-oriented, disease-focused practice, payment model transformation is a necessity. I’ve heard many clinicians say, “We’ll change our practice model when the payers change.” I think that puts too much responsibility on and gives too much credit to payers to transform our health system. As physicians, we are in the best position to transform healthcare delivery and payment models to increase value for patients. We should lead the way and encourage payers and other stakeholders to follow.

To improve value delivered to patients, one must first be able to accurately and consistently measure outcomes and costs at the patient level. Too often we use outcomes measurement as a tool for evaluating our performance at the aggregate level, when in reality, in order to improve value to individual patients, we must measure health outcomes from the patients’ perspective (using patient-reported outcomes) and costs (using time-driven activity-based costing) at a very granular level for every patient. This requires changes in workflow and developing a culture that values and prioritizes outcomes and cost measurement as part of routine clinical practice.

Change is hard! Don't underestimate the inertia one has to overcome if you want to change your practice model. But don't dismiss the opportunity, either, just because it’s difficult to do. We found that with the right leadership, culture, and perseverance, change is possible.

Leadership and culture are the key to making change.  I am frequently asked, “What’s the most important lesson you’ve learned in 7 years of building an entirely new payment and delivery model for musculoskeletal care?” Without question, my answer is committed physician leadership and a culture that embraces continuous change and improvement.

Would You Like to Highlight Your Practice?

Would you like to share a suggestion about your Efficient PracticeCORRelations would like to hear about it, and perhaps feature it in a future post in this section. Please email us to get in touch. Thank you.