Arizona Physician Fall 2021 - FREE

FALL 2021

A P U B L I C AT I O N O F T H E M A R I C O PA C O U N T Y M E D I C A L S O C I E T Y

A Commitment to Quality David Ott, MD, shares how working towards higher quality always brings better patient outcomes

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Physicians across Arizona share their thoughts on value-based care

Village Medical is acutely focused on delivering quality patient care and provide physicians an environment where they can be successful.

- Mark Lewis, MD

At Village Medical, we know the more you can connect with patients, the better care they receive. That’s why we empower providers with a patient-centered, tech-enabled model backed by a clinically integrated care team, to help you deliver better outcomes at a lower cost.

If you’re looking for a change, we’re hiring primary care physicians and advanced practice providers right now, in: • Sun City West • Litchfield Park • Agua Fria

• Vistancia • Maryvale Village • Goodyear

• Anthem • Mesa Central • Chandler East

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© 2021 Village Medical

CONTENTS IN EVERY ISSUE 4 | From the MCMS Board President VOLUME 3 • ISSUE 4

6 | From the Editor-in-Chief

Editor-In-Chief

8 | Briefs

John McElligott, MPH, CPH

22 | What Arizona Docs are Saying

Managing Editor Edward Araujo

26 | Legal Corner

Associate Editor

28 | How To

Mariana Nicolaides

Creative Design

30 | Physician Spotlight

Randi Karabin, KarabinCreative.com

Ben Scolaro, scolarodesign.com ads@arizonaphysician.com

Read how a new value-based care program will change the future of palliative and hospice care.

Maricopa County Medical Society Board Members President John Prater, DO

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Immediate Past President Lee Ann Kelley, MD

Secretary Karyne Vinales, MD

Directors Anne Maiden-Hope, DO, FAAP Jane Lyons, MD Gerald Golner, MD, FAAP Rahul S. Rishi, DO, FAAAAI, FACAAI Shane Daley, MD, FACS Zaid Fadul, MD, FS, FAAFP

Are all physicians on-board with value-based care?

Mariana Nicolaides and Anna Hartman share why and why not.

Advanced Illness Partners

Advertising

Ricardo Correa, MD, ESD, FACP

Buying a Ticket on the VBC Train

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Cover & Physician Profile Photography

Treasurer & President-Elect

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18 C O V E R S T O R Y

Orthopedic surgeon David Ott, MD, shares how working towards higher quality always brings better patient outcomes.

Culturally Competent

Medical student Stephen O’Neill answers what culturally competent healthcare means to him.

Resident & Fellow Director Anchit Mehrotra, MD

Medical Student Director Kristen Bolte, OMS-III

Digital & Social Media arizonaphysician.com ArizonaPhysician @AZPhysician @AZ_Physician

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FROM THE MCMS BOARD PRESIDENT

“ O L D S O L D I E R S N E V E R D I E …T H E Y J U S T FA D E AWAY.” —General Douglas MacArthur in his April 19, 1951 farewell address to the U.S. Congress

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or my final column of the Maricopa Medical Society, I was asked to write an article on a subject I know next to nothing about: valuebased care. The reason for my ignorance on this topic stems back to 2006 when I changed my practice. I was tired of getting shellacked by insurance companies, so I lowered my fees and charged patients directly. I was most satisfied personally and professionally and did very well financially with that model of care. Indeed, many years ago, that is how care was provided to patients.

This coming year will mark my 37th year of practicing medicine. Along the way I have seen many “plans” designed by bureaucrats to improve quality of care and at the same time lower costs. HMOs, PPOs, and other managed care plans have done little to improve care or lower costs. They have resulted in a clever ruse by Medicare and other carriers to transfer progressively more administrative costs to the practicing physician, while at the same time lowering physician reimbursement. In addition, these intrusions into the doctor-patient relationship certainly do not improve patient satisfaction. This is particularly the case these days with EMR’s: the physician interfaces with the computer screen more than the patient. There is no nice way to say it, but here is how I see it: Ironically, as medicine has realized tremendous scientific advances over the past few decades, these improvements have not been able to offset the selfdefeating lifestyle of most Americans. This continues to include poor diet, substance abuse, tobacco use, and inactivity. Along the way, we misplaced the value of preventative care.

It is an incontrovertible fact that the more people placed in between the doctor and the patient, the higher the cost of care escalates. These administrative middlemen contribute nothing directly to patient care and are a large part of the healthcare economic burden we face as a society.

It also appears to me that while our work as physicians has been devalued, the salaries of hospital, insurance, and pharmaceutical executives have grown higher than ever. I wish someone would 4

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tell me the value-added by these higher salaries to improved patient care.

“Value-based care” is the new name for care previously delivered by HMO plans. It appears that IF you have a healthy uncomplicated caseload of patients, you are golden. If not, you must compromise in some way, and we all know what that means.

Clearly, the most cost-efficient care that leads to the greatest patient satisfaction and the fewest unnecessary tests is the doctor-patient model. I have seen all the others come and go. I suspect “valuebased care” will realize a similar fate.

It saddens me to see how medicine (and specifically the practice of medicine) has changed. It further saddens me to know that because of our apathy, we have allowed this to occur. I may be retiring from medicine in the next few years, and like the old soldier I will fade away, but you all know that what I say rings true.

Thank you for the honor to have served as your President of Maricopa County Medical Society in 2021. I promise to remain involved and to help complete the work we promised earlier this year and to help MCMS grow.

Respectfully,

John Prater, DO

Dr. Prater moved from Ft. Myers, FL to Phoenix in 2017 and shortly thereafter became a Director on the Board of Maricopa County Medical Society. He was active at the state and local levels of organized medicine in Florida for decades where he served in several physician leadership positions, including President of the Southwest Florida Psychiatric Society and President of District Eleven of the Southwest Florida Osteopathic Medical Society. He is a board-certified psychiatrist currently practicing at the Phoenix VA Medical Center.

Four-Year Medical School Now Open in Phoenix Medicine | Nursing | Occupational Therapy | Pharmacy Physical Therapy | Physician Assistant Creighton has welcomed the inaugural class to the University’s new 195,00-square-foot health sciences campus in midtown Phoenix. We’re proud to bring a full range of programs to the region and help meet the growing need for providers in the area.

St. Joseph’s Hospital and Medical Center, Valleywise Health, and District Medical Group. The Creighton Alliance will provide access to high-quality teaching environments for Creighton students and residents, and it’s a natural extension of our mission.

This expansion makes Creighton the largest Catholic health professions educator in the U.S., and it was made possible through the Creighton University Arizona Health Education Alliance, a partnership between Creighton University, Dignity Health

As a Jesuit, Catholic university, Creighton has been educating changemakers for more than 140 years.

We’re proud to continue that tradition in Phoenix as we partner to help passionate students become compassionate professionals.

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The Creighton Alliance includes:

FROM THE EDITOR-IN-CHIEF

“Quality is more important than quantity.

One home run is much better than two doubles.”

—Steve Jobs The late Steve Jobs may be correct. It’s exciting to watch a home run and then turn around to high five the fans around you at the ballpark.

Still, a Major League Baseball player has higher chances of hitting a double (5.00% in the 2021 MLB regular season) than hitting a home run (3.78%). The devotion to quality over quantity and easy user interfaces are what drove massive sales of Apple products.

Let’s apply the baseball analogy to medicine, where the value-based care model of reimbursement is pushing physicians to emphasize quality or quantity.

In this issue of Arizona Physician, we examine what the payment system means to physicians, who benefits, and how it could help patients or lower costs to the healthcare system.

Physicians often cite quality of care as their guiding star. You chose medicine to improve the lives of your patients. As a patient, I greatly appreciate any effort to provide the best care at the right price.

How you achieve better quality of care is always changing, as techniques and procedures evolve and improve. Just as in baseball, the rules sometimes change. Payment systems, and their various incentives, have shifted over the decades.

Medicare, for example, was modeled on the fee-for-service structure of the 1960s. As health costs rose, we saw the rise of managed care and capitation models. Since the Centers for Medicare & Medicaid Services (CMS) is the largest payer of healthcare services in the United States, CMS decisions have an outsized impact on the reimbursement models that private insurers adopt.

Additional CMS efforts to rein in healthcare expenditures have led to value-based care of today.

Whether value-based care leads physicians to hit home runs in the operating suite or bedside is yet to be seen. Maybe we’ll see if more singles and doubles in medicine are more valuable than home runs.

S P O T L IG H T ON VA LU E-B A S E D C A R E We greatly appreciate David Ott, MD, of OrthoArizona for speaking with Managing Editor Edward Araujo regarding how the orthopedic surgical practice has adopted the value-based care model and continues to analyze data to drive its decisions.

For our section What Arizona Docs are Saying, we learn about upsides and downsides of valuebased care and how physicians could measure whether quality of care or outcomes for patients has improved.

MCMS interns Mariana Nicolaides and Anna Hartman write about the big picture of value-based care and how difficult it may be for some practices or small hospitals to implement the model. As they state, “Many physicians may question the barriers of transitioning to this model, and whether the change will truly benefit their practice and improve the value of healthcare delivery.”

VA LUA BL E A R T IC L E S David Shelley shares recommendations for having the correct tools and layered security in place to prevent ransomware and minimize the impacts of harmful hacking that is on the rise.

Lawyers Melissa A. Soliz and Helen Oscislawski share updates regarding the new information blocking rule that requires the immediate release of electronic health information to patient portals.

Finally, we congratulate Stephen O’Neill, a medical student at the Mayo Clinic Alix School of Medicine, for winning our annual essay contest. Please read Stephen’s answer to the question of “What does culturally competent healthcare mean to you?”

Contact us at information@arizonaphysician.com with any comments or suggestions.

We are looking for article contributors, podcast guests, and virtual event presenters.

Contact us at info@arizonaphysician.com for these and many more opportunities.

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Enjoy the magazine.

By John E. McElligott, MPH, CPH

BRIEFS

NEWS AND NOTES FROM THE FIELD

3 HEALTHCARE MARKETING TIPS WEB PRESENCE

Lend a Helping Hand The holidays are right around the corner, and there is no better time than now to get out and lend a helping hand.

MISSION OF MERCY | Phoenix,

Mesa | Needing people to drive a medical RV for mobile clinics. amissionofmercy.org/arizona ssimones@amissionofmercy.org CIRCLE THE CITY | Phoenix | Get

involved with event coordination, translation for patients, advocacy, and chaperoning. circlethecity.org msanteusanio@circlethecity.org VALLEY OF THE SUN UNITED WAY | Across the state of

Arizona | Help run vaccine events, create thank you cards for the community, read to children, and much more! vsuw.org volunteer@vsuw.org SOCIETY OF ST. VINCENT DE PAUL | Across the state

of Arizona | The society of St. Vincent de Paul has something for everyone, whether it be preparing food, working at a food or clothing bank, and helping to repair bikes.

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Administrative work and creating family-friendly crafts from home are also available. info@svdpaz.org 602.266.GIVE (4483) to gift a monetary donation FEED MY STARVING CHILDREN | Mesa, Arizona |

Hand pack food for needy children around the globe. fmsc.org info@fmsc.org BETTER PIGGIES RESCUE | New

River, Arizona | Volunteers will help with cleanup and socializing pigs. betterpiggiesrescue.org betterpiggiesrescue@gmail.com ARIZONA ANIMAL WELFARE LEAGUE | Phoenix,

Chandler | Care for cats and dogs, work events and special projects, complete clerical duties, and also work maintenance. aawl.org 602-273-6852

Create a clean and professional website. A website helps for any potential patients to find you and confirm you are qualified for the medical services you offer.

Use a website to establish the brand for you or your practice.

Social media is a big deal. Your practice should have a presence because that’s where patients are active.

Get listed. There are several healthcare directories that act like an online phone book. It’s an easy way for patients to sift through thousands of options by specialty, location, and reviews.

MANAGE REPUTATION

Maintain a good reputation by surveying all patients after each encounter. Ask satisfied patients to provide an online review. Drill down on negative remarks and follow-up with those unhappy patients to resolve issues.

WATCH TRENDS

Patient portals. Many practices and hospitals allow patients to schedule appointments and view documents through an online portal.

Content is king. Share your thoughts and expertise through blogs, social media posts, audio clips, or short videos. Educate patients in a fun way that is both engaging and shows you are an authority in your specialty or local area.

Go mobile. Ensure your website and the information you share can be easily read on mobile devices.

6 GREAT BY THE FIRE FICTION READS Fall is upon us, and cold weather makes staying inside inevitable. All you need is a cup of hot chocolate and a good book to keep you warm and let your imagination run wild. From history, mysteries, science fiction, romance, fantasy, crime thrillers, to classic fiction; there is a fiction book to be enjoyed by all. Here are 6 great examples and small insights by critics.

CIRCUS OF WONDERS by Elizabeth MacNeal | Set in a spectacular circus in the pleasure gardens of Victorian London, this is an addictive novel about power, fame, and a love that is threatened by a terrible secret.

SHUGGIE BAIN by Douglas Stuart | A heartbreaking story of addiction, sexuality, and love, Shuggie Bain is an epic portrayal of a workingclass family that is rarely seen in fiction. Recalling the work of Édouard Louis, Alan Hollinghurst, Frank McCourt, and Hanya Yanagihara, it is a blistering debut by a brilliant novelist who has a powerful and important story to tell.

CITY OF TEARS by Kate Mosse | A gripping, breath-taking novel of revenge, persecution and loss, the action sweeps from Paris, Chartres, and London to the city of tears itself, Amsterdam. The second in Mosse’s Number One Bestselling, The Burning Chambers quartet.

THE HITCHHIKERS GUIDE TO THE GALAXY by Douglas Adams | Douglas Adams’s mega-selling pop-culture classic sends logic into orbit, plays havoc with both time and physics, offers up pithy commentary on such things as ballpoint pens, potted plants, and digital watches… and, most important, reveals the ultimate answer to life, the universe, and everything.

THE LIBRARY OF THE DEAD by T.L. Huchu | Sixth Sense meets Stranger Things in T. L. Huchu’s The Library of the Dead, a sharp contemporary fantasy following a precocious and cynical teen as she explores the shadowy magical underside of modern Edinburgh.

THE WAY OF KINGS by Brandon Sanderson | The Way of Kings is an epic fantasy novel written by author Brandon Sanderson and the first book in The Stormlight Archive series. The story rotates between the points of view of Kaladin, Shallan Davar, Szeth-son-son-Vallano, Dalinar Kholin, and several other minor characters, who lead seemingly unconnected lives.

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CHRISTO’S | From tasty lobster,

shrimp ravioli, to veal dishes. Named one of the “17 Best Trattorias in the United States,” by USA Today. Christo’s ambience, food, wine, and service bring you both an old-world eatery with a romantic atmosphere which allows you to travel back to a simpler time.

5 Amazing Authentic Italian Restaurants in the Phoenix Metro Area

(602) 264-1784 | christosristorante.com MORA ITALIAN | A fresh take on

authentic Italian. This swanky uptown Phoenix eatery brings homemade pasta to a new level. From Pasta Al Pomodoro to the incredibly tasty Tagliatelle, Chef Scott Conant brings the delicious flavors of the old world onto the new.

(602) 795-9943 | moraitalian.com

Fall is here, and the time for a hearty meal with a glass of wine is now. Here are the five great Italian restaurants in the Phoenix Metro area that you should patronize.

MICHELINA’S ITALIAN RESTAURANT | Michelina’s brings

you a taste of southern Italy. From the homemade sausage & peppers linguini and shrimp Michelina, to the

incredible lamp chop, lighty seasoned to perfection. There’s something for everyone.

(602) 996-8977 | michelinasrestaurant.com TOMASO’S | Tomas’s famous veal osso

bucco is just the beginning of the journey at this authentic Italian eatery.

Tomaso Maggiore restaurant’s origins are in the old world, but they have created an undeniably fresh identity here in the Camelback corridor. From fine Italian food, steaks, wine to an elegant ambience, you’ll leave satisfied and ready to return.

(602) 956-0836 | tomasos.com PICAZZO’S HEALTHY ITALIAN KITCHEN PARADISE VALLEY | Are you vegan?

Vegetarian? This may be a great place for you. Enjoy vegan and gluten free pizza as well as multiple pasta combo options.

The vegan spicy Thai peanut quinoa bowl will drive up your taste buds.

(602) 923-6001 | picazzos.com

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for drawing top talent, and the mainstage performance space seats 470 patrons, all with an unobstructed view of the stage. | azbroadway.org SCOTTSDALE CENTER FOR THE PERFORMING ARTS | The Scottsdale Center For The Performing Arts brings both traditional and contemporary art to its audience.

There are numerous performances to experience at the Center, such as speakers, dance, music, and acting performances. | scottsdaleperformingarts.org

Keeping Up with the Arts THE PHOENIX SYMPHONY: THE PHOENIX SYMPHONY HALL | The Phoenix Symphony is the only full-time, professional symphony orchestra in Arizona, as well as the largest performing arts group in the state. Concerts feature world-renowned conducors, guest artists, and have a selection of programs, such as classics. | phoenixsymphony.org BALLET ARIZONA | Ballet Arizona is a professional ballet company that performs both classical and contemporary ballet around the Phoenix area. The company consists of

about 30 dancers led by Ib Andersen, an internationally acclaimed choreographer.

Future shows include productions such as The Nutcracker and Romeo and Juliet with music performed by The Phoenix Symphony. | balletaz.org THE ARIZONA BROADWAY THEATER | The Arizona Broadway Theater (ABT) is an “all in one entertainment experience”, where patrons can enjoy high-end sit-down table service from a themed menu based on the production. ABT has a national reputation

THE ORPHEUM THEATRE | Built in 1929, the Orpheum theatre is home to a number of events, such as Broadway and musical performances. Tours are also offered, allowing guests to explore both public and non-public areas of the theater. | fototphx.org CHANDLER CENTER FOR THE ARTS | Located in downtown Chandler, the Chandler Center for the Arts has a rich history of art and architecture. Whether it be music, theater, comedy, or dance the center is sure to have something for everyone. | chandlercenter.org

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Buying a Ticket

VBC TRAIN? I on the

mprovements in medicine and public health efforts have increased life expectancy over the last decade, meaning on average people are living longer, and leaving more than 50% of adults in the U.S. with at least one chronic illness (CDC, 2020). With chronic illness so prevalent in the adult population, many have questioned how healthcare delivery can be improved, so patients not only can better maintain their conditions, but live longer and more fulfilling lives. This is where value-based care (VBC) comes in. Value-based care is a healthcare reimbursement model that focuses on quality over quantity, and rewards providers for performance and effectiveness.

In a VBC model, integrated healthcare teams work with patients to provide an individualized treatment option, instead of the patient recieving care seperately at several different institutions.

VBC is rapidly gaining popularity in hospital networks and small medical practices, as it works to enhance patients’ experience of care, improve health outcomes of populations, and minimize the per capita cost.

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Value-based care was started by the Centers for Medicare & Medicaid Services (CMS) to reduce long-term federal spending on healthcare. It differs from the common fee for service (FFS) model because it does not focus on volume of care. As time goes on, an increase of access to data, treatment advancements, and the use of increasinglly powerful technology will only continue to individualize medicine, and create a space for healthcare providers to more easily collaborate and provide better care.

“This is the future,” according to Dr. Denis Cortese, Professor and Director of ASU Center for Healthcare Delivery and Policy, and Emeritus President and CEO of the Mayo Clinic. Dr. Cortese says, “Physicians will have to start working together. Does that mean physicians have to be owned by hospitals? Absolutely not. Does that mean physicians have to become integrated and work among themselves? Absolutely.”

THE IMPACT OF AN AGING POPUL ATION An aging population presents the U.S. healthcare system with a significant problem. By 2034, it is expected that adults over 65 years of age will exceed the number of children under 18 for the first time in modern American history (see Figure 1). A recent estimate in 2020 by the Kaiser Family Foundation showed 62 million people are eligible for Medicare coverage in the United States. The value-based care payment model addresses the needs of all ages, but it will directly impact U.S. federal funding of the population 65 and older through Medicare. In 2018, Medicare spending reached $583 billion. The increase in the older population and higher healthcare prices will contribute to more Medicare spending, likely amassing to nearly $1,260 billion in

Figure 1

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2028. This foreseeable increase in healthcare cost for the older population gives healthcare providers a greater incentive to implement value-based care, and the shift towards patient empowerment has been leading patients to search not only for the best quality healthcare but the best quality with the best possible value.

IS A VBC MODEL FOR EVERY PHYSICIAN? Launching a VBC model is not simple, and some physcians may struggle more than others. Many physicians may question the barriers of transitioning to this model, and whether the change will truly benefit their practice and improve the value of healthcare delivery. Hurdles in transitioning to a VBC model include a lack of system integration, outdated workflows, limited internal resources, and inaccessible clinical data (Bartlett, 2021).

Organizations which lack these abilities may find it extremely difficult to reach VBC objectives, leaving physicians with substantial financial penalties due to negative outcomes (DECO, 2021). Barriers and financial penalities are not the only reason a physician may shy away from this model. Additional strain may also be put on physicians, as many may feel they would be responsible for wellness issues beyond their common practice.

When asked what changes physicians may see when transitioning to this payment model, Dr. Cortese opined the main compromise physicians may experience is “...Giving up a degree of autonomy.” Physicians should be practicing based on science within the evidence-based medicine framework. Meanwhile, he says, “[Doctors] should have autonomy on how to deliver the best thing [care] in partnerships with their patients.”

So, can a VBC model ultimately benefit both the patient and physician? Dr. Cortese believes so, stating, “Payment models that have been the most successful in resulting in highest value care and

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have worked the best have been the full capitation models and bundled payments.” Bundled payments are episode based, meaning that patients pay a single price for an episode of care. If a physician can save money and provide an effective course of treatment, then they can keep the savings. On the downside, if the cost is higher than intended, the physican must cover the cost. Since a physician can either keep the savings, or otherwise cover the cost, this model then incentivizes the physician to search for better, more efficient ways to provide quality care.

(DECO, 2021). In a capitation model, a physician is paid in advance through a fixed amount of money per patient per unit of time. Capitation payments control use of health care resources by putting the physician at financial risk for services provided to the patients (ACP, n.a.).

While this idea may be ideal to some physicians, ultimately a VBC system may not be for everyone. In his experience, Dr. Cortese predicts, “Physicians are going to have to practice in a learning system environment so they can stay current.” Value-based care is building momentum. Some physicians in Arizona may need to get on board or risk the VBC train passing them by. ■

Mariana Nicolaides, BSPH Associate Editor Arizona Physician mnicolaides@mcmsonline.com

Anna Hartman, MPH Candidate University of Arizona hartmana@arizona.edu

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Advanced Illness

Partners

A new Hospice Value-Based Care Model

H

ealthcare is quickly evolving these days and providers, hospital groups, and private and government health plans are all looking toward value-based care as a way to improve outcomes and lower cost. Over the past several years, a variety of value-based programs and ideas have been implemented across the spectrum of healthcare that share the same goal: to shift the incentives in healthcare from those driven by volume to those driven by outcomes and quality.

A common tenet of value-based care is flexibility. Typically, providers are paid a set monthly amount to oversee care of a

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patient. When the care results in savings, those savings are shared with the physician. Conversely, the physician also may bear part of the risk if outcomes are not as hoped. Care is determined by patient need and is not limited to provider office visits.

Physicians can determine which patients need the most “touches” and what those encounters should be. Patient management can move beyond the traditional office visit and could encompass a variety of innovative strategies: telehealth, group education, use of health coaches, involvement of community resources, etc. Such a model allows for creativity and empowers each member of the healthcare team to function at their highest level of skill and training.

BR I NG I NG HO S P IC E P R O V I DE R S T O G E T H E R One of the most promising populations for whom value-based care could have a dramatic impact is people living with long-term chronic diseases, especially those who are geriatric or have significant social factors that impact their healthcare.

Often, such patients have challenges accessing and navigating the healthcare system, resulting in poor control of their illnesses and subsequent frequent hospitalizations. Addressing their needs through a multimodal and wide-ranging approach can interrupt the negative feedback loop of fragmented care that leads to emergent hospital stays and further fragments care. Managing patients comprehensively and proactively in their homes is just good medicine.

Hospice of the Valley is one of seven nonprofit healthcare agencies nationwide that have come together to offer an innovative value-based program to care for people with complex chronic illnesses. The joint venture, Advanced Illness Partners or AIP, is part of a sixyear pilot study commissioned by the Centers for Medicare and Medicaid Innovation. Besides Hospice of the Valley, the other nonprofit partners include: Hope Healthcare, Housecall Providers, Cornerstone Hospice, Nathan Adelson Hospice, Capital Caring Health, and Pure Healthcare, which is part of Ohio’s Hospice, a group of 10 affiliated providers located throughout that state.

Combined, these seven providers care for nearly 60,000 patients each year. Recognized as leaders in the field of value-based care, they create innovative programs that lower cost, but improve the care of high-needs patients with complex illness. Costs to start the venture are relatively modest and primarily relate to contracting for data analytics. Much of the infrastructure for care is already in place as a result of the hospice and palliative programs managed by AIP member organizations. AIP will receive a riskadjusted monthly payment for eligible patients and will share risk for 50% of shared savings or losses for Medicare Part A and B services.

The top priority of AIP will be to deliver costeffective, high-quality, primary care to patients with advanced disease who find it difficult to visit a doctor or access the healthcare system. Hospice

of the Valley provides this comprehensive care to our community through Geriatric Solutions, a practice that brings primary care to home-limited patients throughout Maricopa County. The AIP project now enables the physicians and nurse practitioners working with Geriatric Solutions to marshal the resources Hospice of the Valley uses for hospice and palliative care patients for the benefit of a primary care geriatric population.

A I P MODE L BE N E F I T S In the 20 years I worked in a private family practice, I cannot tell you the number of times I wished I had readily available social work or nursing resources for my patients who would come with problems that went well beyond what I could offer them as a physician. Patients cared for under the AIP model can take advantage of all these services and more. Those who would benefit most from social worker services can obtain them. Those who need nursing visits can have them. Ongoing education on disease management for patients and caregivers alike can be provided by respiratory therapists, dementia counselors and a variety of nurse specialists. When faced with a crisis in the middle of the night, patients can speak with a registered nurse (not an operator or an answering machine), who triages the concern and even sends a nurse if needed. All patients have access to this 24/7 support.

This program provides a large safety net to help keep these vulnerable patients from slipping through the cracks of the medical system. The team-based approach is comforting to a population that often feels alone and anxious. Having a specialized team come to them is an enormous boost to both body and spirit.

It is exciting to be able to offer a service aimed at providing care best suited to an individual patient when and where they most need it. We are confident this innovative approach to home-based primary care will result in fewer hospitalizations, significant cost savings and, most importantly, better care for some of our community’s most fragile patients. ■

By Ned Stolzberg, MD Executive Medical Director Hospice of the Valley nstolzberg@hov.org

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DAVID OTT, MD

A Commitment to

QUALITY THROUGH VALUE-BASED CARE

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avid Ott, MD, is a passionate and wellrespected Orthopedic Surgeon who is proud to provide the highest quality of orthopedic care to the Arizona community. To Dr. Ott, it begins with his patients and the trust they bestow on him from the initial visit, to follow up appointments, and surgery. Patients leave, knowing Dr. Ott is fully invested in their overall health and confident that Dr. Ott’s operating skills will improve their mobility.

“It’s extremely humbling when you realize a one-hour operation can give people back their existence!” exclaims Dr. Ott.

TREATING OR FIXING Treating patients or fixing patients. That is a dilemma many physicians face early in their careers. The answer does not always come easy. For Dr. Ott, it happened during medical school at UCLA, where he originally wanted to be an internist. Yet, he found that he was good at the procedural aspects of medicine. His internal medicine rotation left an impression that “we treated a lot of people, but we weren’t fixing patients,” he says.

At UCLA, Dr. Ott enjoyed having access to surgical tools. Often, patients left better than when they first came to see him, and some were completely

back to normal function. That sense of fulfillment has driven his career for the last 35 years.

“In orthopedics, I’m honored by the fact that we get to actually eliminate people’s problems,” says Dr. Ott in his office at OrthoArizona, a growing practice he co-founded.

Dr. Ott has focused his practice on joint replacement, especially hip and knee replacements. He states, “The Lancet described the hip replacement as the operation of the century and that was before we had some of the technology we have now, which has made it even better.”

“When someone comes in miserable, and their quality of life is markedly impaired, they just cannot do what they want to do, whether its playing with their grandkids, walking up and down stairs, going to the grocery store, going for a hike. Then we give that back to them, it’s really wonderful” says Dr. Ott.

CLINICAL AND ADMINISTRATIVE WORK A day in the life of an orthopedic surgeon and administrative executive like Dr. Ott, may not be typical. Clinically, Dr. Ott will typically see around four to six new patients and around fifteen follow up patients by midday. He sometimes has three operations each afternoon. His day would not run

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“In orthopedics, I’m honored by the fact that we get to actually eliminate people’s problems.”

well without the assistance of his physician assistant, Christopher Rubio, who has been with him for 11 years, and a talented team of nurses and certified nursing assistants.

Dr. Ott is a co-founder and Senior Vice President of Operations at OrthoArizona. He remains focused on improving the patient experience and, as he calls it, “doing things the right way.” From the creation of an outpatient surgery center to collaborating with Dignity Health to build Oasis Hospital which has some of the highest HCAHPS in Arizona, Dr. Ott’s imprint on excellence, hard work, and better patient care stands out.

VALUE-BASED CARE According to Dr. Ott, the concept of valuebased care was promulgated because physicians were paid for treating sick, injured, and wornout people, but not for preventing people from getting sick or reducing injuries.

Uwe Reinhardt, Ph.D., one of the foremost health care economists who wrote about

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value-based care, stated it was a utopian view. That view emphasized physicians guiding patients properly, helping to reduce the burden of disease and disability.

“The global perspective is extraordinarily difficult to implement, because when you get down to it, physicians are individual providers one-on-one with patients in an exam room,” Dr. Ott states. He believes value-based care will not work for individual physicians as it only works when you have a group of physicians working together.

VALUE-BASED CARE IN ORTHOPEDICS From 2013 to 2018, the Center for Medicare & Medicaid Services (CMS) held the Bundled Payments for Care Improvement (BPCI) elective initiative. It was compromised of four broadly defined models of care, which linked payments for the multiple services beneficiaries received during an episode of care. The original program allowed participating providers to choose from 30, 60, or 90-day reimbursement bundles.

BPCI would not reimburse physicians for complications after a total knee replacement, for example. The paradigm had shifted from fee for service and would make physicians or practices responsible for the entire ninety-day episode of care to be paid through a target price negotiated with CMS. Other costs like anesthesia, post-surgery care, skilled nursing, acute rehabilitation, home health, or readmissions, even if it is a readmission unrelated to the orthopedic surgery, would all be deducted from the negotiated rate. Yet, if the total costs for an episode of care came under the target price, then the physician or practice would keep the difference.

VALUE-BASED CARE AT ORTHOARIZONA Dr. Ott played a pivotal role in OrthoArizona’s decision to join the BPCI program. At the time OrthoArizona, was doing around 1,800 Medicare knee and hip replacements per year. They decided to plunge into value-based care, knowing they could minimize risk by having 68 physicians on staff. Per Dr. Ott, “As an individual provider, taking on patient complications or any post -surgery risks, makes this reimbursement plan unfeasible.” OrthoArizona and CMS negotiated a target price based on historical costs.

Administering the shift to value-based care, Dr. Ott, and the team at OrthoArizona found ways to reduce costs. Referring patients outside of the group was not necessary for patient outcomes and only increased costs. Pre-BPCI, OrthoArizona was using home health care around 60-80% of the time, skilled nursing facilities and acute rehab centers about 30-40% of the time.

Recognizing that these were often unneeded treatments, the group developed surgeon driven protocols, implemented through the nurse case managers and navigators, OrthoArizona was able to reduce the utilization of these services to 5-10% of the time.

Cost reductions and patient quality are connected.

Dr. Ott and the OrthoArizona team analyze data to better identify patients who are at risk for bad outcomes from surgical procedures. Among the 800 employees at OrthoArizona are a program director, nurse case managers, and navigators who ensure patients receive resources they need before and after surgery. Fewer complications lead to more profit under the negotiated rates.

OrthoArizona also implemented internal key performance indicators (KPIs) that would hold all physicians accountable. KPIs such as home health care usage, skilled nursing usage, readmission rate, average readmission cost, target price, total episode of cost, etc., now factor into which surgeons they retain or external partners they use for care.

DOES VALUE-BASED CARE HAVE A FUTURE? Dr. Ott says, “Value-based care done properly incentivizes and rewards quality. Yet, there is still a volume component that needs to be tied to it. It also has an accountability and warrantying of work that doesn’t exist in traditional fee for service.”

OrthoArizona has set a high standard that all physicians agree to pursue. “The organization is constantly measuring and evaluating their quality of services because that’s the future of healthcare,” says Dr. Ott.

On the Personal Side with Dr. David Ott Q: If you could describe yourself in one word, what would that be?

A: Tenacious Q: Do you have family? Pets?

A: JoAnn my wife of 34 years, Logan, my 27-year-old son, Kendall, my 23-year-old daughter, and my 2 golden retrievers, Daisy and Bear.

Q: Do you have a hidden talent most people wouldn’t know about you?

A: Heli-skiing Q: What career would you be doing if you weren’t a physician?

A: An Architect Q: What book are you reading right now, or recently?

A: A Course Called Ireland: A Long Walk in Search of a Country, a Pint, and the Next Tee

by Tom Coyne

Q: What’s your favorite movie?

A: The Deer Hunter directed by Michael Cimino Q: What’s your favorite local restaurant?

A: Tee Pee Mexican Food Q: Do you have a favorite sports team?

What is it?

Arizona Cardinals

Q: What’s your favorite activity outside of medicine?

A: Playing golf

David Ott, MD, has been an advocate for outcomesbased reimbursement since he started practicing medicine. Quality is a staple of the orthopedic surgeries he provides. He is proud of the shift he and his colleagues have made to align their approach with value-based care. ■

By Edward Araujo Managing Editor Arizona Physician earaujo@mcmsonline.com

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What

Arizona

DOCS are Saying Why does your practice or employer use a value-based care model?

We are a quality-driven organization and we embraced this early to align incentives with our quality. —Kipling P. Sharpe, MD A waste of time. Excellent care is not always measurable. —Jay Friedman, MD Patient demand. —Anthony Yeung, MD Health outcomes are improved, and our revenue is increased. —Arthur Chou, MD

What is the biggest upside from using a value-based care model?

Less waste and better outcomes — get rid of the profit motive. —Donald A. Opila, MD Comprehensive evidence-based care reminders on each patient from data analytics. A whole picture snapshot is available each visit for each patient and snapshots of the patients who don’t come in. —Susan Whitely, MD Potential in improving the quality of healthcare while reducing cost. —Arthur Chou, MD

What is the biggest downside from using a value-based care model?

The financial risk of things that are truly out of your control. —Kipling P. Sharpe, MD Value based care is not only based on outcomes but efficiency. Efficiency is another way of saying less costly to the insurance company. This is not in the patient’s best interest. At times, we may need to opt for treatments that are in the patient’s best interest but may not be viewed as being inefficient by the insurance company because it costs more. —Rahul Rishi, DO Cut in incomes of MDs who are gaming the system.

—Donald A. Opila, MD The constant influence by payers, government, and competing providers all trying to survive by maximizing income. —Anthony Yeung, MD Lower reimbursement. —Nathan Laufer, MD

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Read more about what these docs are saying about value-based care at arizonaphysician.com.

Learn more about the participating physicians How do you measure whether quality of care or outcomes for patients has improved?

We have extensive metrics on re-admissions, ER visits, and complications. —Kipling P. Sharpe, MD Measure less emergency room and urgent care use and fewer hospital admissions. Less use of or reliance upon prescription and OTC medication over time. Also, ask patients about quality of life. —Rahul Rishi, DO Patient choice, satisfaction, and safety with decreased complications. —Anthony Yeung, MD The payors have data on each patient, from medical loss ratio to ER visits, ER readmits, but even more importantly to me, chronic disease management parameters in patients and populations, for example, diabetic A1Cs, lipids, or vaccine compliance rates.

—Susan Whitely, MD

Kipling P. Sharpe, MD PRACTICE | OrthoArizona PHONE | 480-964-2908 WEBSITE | orthoarizona.org Rahul Rishi, DO, FAAAAI, FACAAI PRACTICE | Arizona Allergy Associates PHONE | 480-897-6992 WEBSITE | azallergy.com Jay Friedman, MD, FACP PRACTICE | Adult Internal Medicine of North Scottsdale PHONE | 480-391-0707 WEBSITE | jayfriedmanmd.com Donald A. Opila, MD PRACTICE | Donald A. Opila, MD, PLC PHONE | 480-994-1166 WEBSITE | honorhealth.com

Anthony Yeung, MD PRACTICE | Desert Institute for Spine Care PHONE | 602-944-2900 WEBSITE | sciatica.com Susan Whitely, MD PRACTICE | Healthy Outlook Family Medicine PHONE | 602-230-0777 WEBSITE | healthyoutlook familymedicine.com Arthur Chou, MD PRACTICE | Horizon Health and Wellness PHONE | 833-431-4449 WEBSITE | hhwaz.org Nathan Laufer, MD PRACTICE | Heart & Vascular Center of AZ PHONE | 602-307-0070 WEBSITE | heartcenteraz.com

What does value-based care mean to you?

It is a term created by insurance companies to reduce their costs at the expense of the patient’s healthcare. —Rahul Rishi, DO Red-tape, employee burn-out and another layer of governmental bureaucracy. —Jay Friedman, MD Needs a team effort in a very fragmented healthcare system with numerous unaligned incentives.

—Donald A. Opila, MD It means getting off the E/M reimbursement treadmill in my specialty requiring a 25-40 patient day to make a living. It means reconfiguring office staff to bring in the patients who hide from us. It means using data in a meaningful way to help me address multiple complex medical needs. Simply put, better medical care for patients and more equitable reimbursement for physicians. —Susan Whitely, MD Opportunity to make healthcare more accountable and truly see if we can improve healthcare outcomes. —Arthur Chou, MD

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Culturally Competent Pursuing Deeper Human Understanding with Scientific Rigor

BY STEPHEN O’NEILL, MS-II, MAYO CLINIC — ALIX SCHOOL OF MEDICINE

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cience is the art of asking questions, and centuries of questions have been asked with the sole purpose of helping providers better understand the patients before them. Posing grand questions about the nature of existence allows us to describe the nature of the individual in new ways we had not previously thought of. For example, there was a time when we knew nothing of genetics or the social determinants of health, but now we regularly describe patients in the context of nucleotide polymorphisms or their social environment. So, when you consider your patient—plainly draped in a poorly patterned gown, shifting uncomfortably on exam table paper—consider that Nobel Prizes have been awarded on behalf of elucidating the mysteries of that individual. In academia it is understood that the more we learn about an individual, the better we can treat them. Cultural competence is an application of that academic truth: the more we understand an individual, the better we can care for them. It not only makes the patient-provider relationship more meaningful, but it improves our ability to understand the intricacies of our patient.

To say that cultural competence is a preformed understanding of someone’s ethnic background or geographical location is too limiting. Culture is complex and protean and may even be difficult for an individual to define about themselves, so we

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should not assume a person’s culture is limited to our understanding of it. Cultural competence exists through a desire to learn about others by giving them the opportunity to be understood as they understand themselves to be. It is a practice that requires humble questioning and space. In fact, cultural competence largely exists in the space between asking a question and receiving an answer. It is here that patient and provider take account of each other; the patient will decide if they can truly share themselves with the provider, and the provider will decide if they are truly willing to listen. If we do not show genuine interest in learning from our patient, we risk treating a façade.

How, then, will we say we have improved someone’s quality of life if we have no sense of what gives their life meaning?

Defining Cultural Competence Healthcare providers will appreciate that within the confines of the exam room they may be interacting with the most private aspects of a person’s life, but we should be careful not to conflate this with the idea that we are automatically interacting with the most important aspects of a person’s life. A physical exam is a deeply personal interaction, but a personal

interaction alone will not divulge the intricacies of a patient’s humanity. This is why it is necessary to define cultural competence as a conscious process and not a trait. It is the process of asking, listening, and learning. The exam room merely provides the opportunity for meaningful interaction but does not confer it; it is up to the provider to ensure the encounter is made meaningful by learning about the culture that defines their patient.

The Key to Cultural Competence The opportunity to interact with patients in this intimate manner is a well-respected privilege. Each interaction offers the chance to learn a great deal about humanity, but applying cultural competence allows us to learn about humanity in ways more central to our being than the subatomic forces that stitch together our miles of DNA. This is why we use the word “sacred” to describe the patientprovider relationship. It is sacred because if we approach it with humility and cultural competence, we have the ability to learn profound truths about people and the world we inhabit.

…It is necessary to define cultural competence as a conscious process and not a trait. It is the process of asking, listening, and learning.

Ultimately, cultural competence should be just like science: ask questions because you are inspired to do so. A humble awe of the natural world has always driven science forward, and the complexity of an individual should stir no less wonder. There will always be more to learn about the world around us and those in it, so we should use all of our faculties to do so. The key to cultural competence is that we approach learning about others with the same dedication that we have used to unearth the mysteries of our biology, because, at the end of the day, novel discoveries in either realm have the same result: a better understanding of the human in the gown, on the exam table, in front of us. ■

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LEGAL CORNER

At the Click of a Button

The New Information Blocking Rule Requires the Immediate Release of Electronic Health Information to Patient Portals

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tarting April 5, 2021, certain health care providers and other actors are required to comply with the new Information Blocking Rule (IBR). The IBR prohibits providers from knowingly engaging in any practice that is unreasonable and likely to interfere with the access, exchange or use of electronic health information (EHI), unless the interference is required by law or qualifies for an exception (aka safe harbor protection). There are eight (8) exceptions—Preventing Harm; Privacy; Security; Infeasibility; Health IT Performance; Content and Manner; Fees; and Licensing. A health care provider claiming safe harbor protection must be able to demonstrate that such provider satisfied all conditions of the applicable exception at all relevant times.

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The U.S. Department of Health & Human Services (HHS), Office of the National Coordinator (ONC) is accepting IBR complaints through its Information Blocking Portal on ONC’s website, HealthIT.gov. The HHS Office of Inspector General (OIG) has authority to investigate claims of information blocking against both provider organizations and individuals. If the OIG determines that a provider has violated the IBR, it will refer the provider to the appropriate agency for disincentives. HHS has not yet released the proposed rule for provider disincentives. Thus, IBR regulatory enforcement actions against providers will be delayed until the provider disincentives rule is finalized.

For more information on this article please visit arizonaphysician.com/Click-of-a-Button

Learn more about the ONC’s Cures Act Final Rule on Information Blocking at healthit.gov/curesrule

Providers should use this grace period to align their practices which affect the access, exchange and use of EHI with the IBR’s requirements and applicable safe harbor protections.

Examples of practices that may implicate the IBR include a provider delaying patient access to EHI or denying a request for EHI when none of the safe harbor protections apply. ONC is particularly focused on ensuring that patients and their legal representatives have immediate electronic access to their EHI requested through a patient portal.

ONC considers the act of logging into a patient portal or requesting access to a patient portal via an application programming interface (API) to constitute an EHI “request” for purposes of the IBR. Therefore, if a provider has adopted a blanket practice of delaying the immediate release of EHI “for any period of time”

(e.g., delaying release of lab results until the ordering physician reviews and approves release), this will likely constitute an interference that implicates the IBR. ONC explains: [I]f there is a general policy to withhold test results for some period of time say 72 hours before the results are made available to the patient . . . that’s probably going to be an interference. The policy under all of this is that now there’s an expectation that [EHI] is available when and where it’s needed. So[,] these generalized policies like that are going to be an interference, unless you meet an exception, or there is another element missing, and we know this is a big transition for folks who are ordering these tests for lots of people, but as a member of our clinical team here at [ONC] often reminds us Congress passed this law because of the overwhelming good that’s going to come from it.

With the exception of a few states that may legally require some delay on the electronic release of EHI, most blanket policies that adopt such practices with regard to a patient portal will not qualify for safe harbor protection. ONC has determined that blanket delays do not qualify for the Preventing Harm exception because it requires a clinician who has a past or present clinicianpatient relationship with the person who is the subject of the EHI to make an individualized determination that the withholding EHI from a patient would “substantially reduce a risk to… life or physical safety.” HHS specifically found that “[n]o commenter cited evidence that routinely delaying EHI availability to patients in the interest of fostering clinician-patient relationships substantially reduces danger to life or physical safety of patients or other persons…” However, ONC has indicated that providers are still permitted to honor an individual’s choice to opt out of having EHI immediately released, so long as the provider does not improperly influence the individual’s decision.

Providers should identify practices that impose such delays on the release of EHI to their patients’ portals. Such practices should be modified to permit the immediate release of EHI. In ONC’s view, a patient should be able to access test results at the same time such results are made available to the ordering clinician. ■

Melissa A. Soliz, JD Partner Coppersmith Brockelman PLC msoliz@cblawyers.com

Helen Oscislawski, JD Partner and Founder Oscislawski LLC helen@oscislaw.com

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HOW TO

IT Security Should be Built in Layers “A secure network environment needs to have a security directory where all devices authenticate to.”

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n recent years there was an increase of hacking effort in the general marketplace and in particular, healthcare. There was hacking in healthcare because of legacy systems and established vulnerabilities. Presented in the media over the last three years were several large healthcare organizations affected by ransomware attacks. The main reason for this occurrence is organizations not having the correct tools and layered security in place.

A secure network environment needs to have a security directory where all devices authenticate to. There are many strong and legitimate directory structures that could be leveraged, but the most widely used is Active Directory. When there is a directory structure in production it eliminates the need of mapping direct drives for users and the impact of an infected machine with Crypto locker. This directory allows you the ability to force group policy amongst the user base and limit what the user

can and cannot do. For example, not allowing users to launch executables is a powerful administrative tool to protect the environment. Another action that should be adhered to is having a password policy in place that changes every 90 days and has certain security criteria. The password should be 10 to 12 characters, contain one uppercase letter, a number, and a symbol.

Another security action to be considered is installing two factor authentication (2FA) on every device within the production environment. It would encompass all laptops, all tablets, and all third-party devices.

All production applications should be set up for 2FA to ensure validity. There is no difference between if this application is a local client on your machine or a website in the cloud, 2FA should be configured.

If your environment is leveraging some type of session-based technology such as RDS/Citrix/VDI, this should also be configured with a 2FA, and all VPN connection should be set up in this manner.

In the next section I will discuss one of the most important security layers that needs to be in place in this security climate, a Next-Gen antivirus that manages threats. These types of antiviruses are constantly scanning the device for odd behavior, weird characteristics, and odd commands displaying the characteristics of an external presence. This type of software is built to address ransomware-like viruses.

The next security layer to be addressed is ensuring that the organization has a viable commercial grade firewall. This device should have intrusion protection service, geofencing, deep packet inspection, as well as the ability to filter web traffic in order for the appliance to block malicious websites.

Another key security layer that should be addressed is email security involving spam services.

There should be a spam service in place that addresses spam and impersonation protection as threat protection regarding links within emails. This protection will prevent any links within emails sent to your users, and emails that are spoofed.

The final action is having a viable commercial backup solution in place that is point-in-time which is having a backup solution that allows your System

“Technology is ever changing, and it is critical to remain current on what methods and tools hackers are leveraging.”

Administrator the ability to restore to a specific time and date. When architecting a backup solution, you should consider the following:  The backup data repository should be replicated offsite to a third-party location.  The onsite backup system should not be able to access the third-party data repository for administration.  The on-premises backup system should be segregated via VLAN from the production environment.  There should be an established data retention plan that documents the timeline for keeping data.

To conclude, there is not a silver bullet approach to address all security vulnerabilities in today’s marketplace. It is the responsibility of the organization to take the right steps to secure the proactive measures of different actions, policies, and security tools in order to protect your environment.

Insurance companies are requiring some of the actions discussed above, and I believe these actions will be a requirement to be insured in the next 15 months. Technology is ever-changing, and it is critical to remain current on what methods and tools hackers are leveraging. It is efficient to be proactive than reactive. ■

David Shelley President, BVA Inc. david.shelley@bvainc.com

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PHYSICIAN SPOTLIGHT

Mark R. Stephan, MD, MBA, of Equality Health in Phoenix, AZ shares his thoughts on value-based care.

Q: How has Equality Health® incorporated

value-based care into its model?

A: By distilling down the health plan contract performance elements combined with actionable information to put in the primary care practice’s hands to deliver high quality, efficient care. Our CareEmpower® platform is a multipayer population health tool so administrative burden is reduced for the primary care office.

Q: Has the Equality Health team seen

improvements in the care experience for patients or a reduction in per capita costs?

A: Yes, both. Quality as measured by prevention metrics, disease management metrics and avoidable acute care events has improved year over year. Combined, total health care costs for the population have been reduced while delivering more appropriate ambulatory care visits.

Q: Do you believe value-based care is leading

to greater consolidation of primary and specialty care practices with provider network organizations like Equality Health?

A: It certainly reduces administrative burden for the health plan to consolidate value-based agreements with many, particularly smaller, practices. For practices, tying your raft to a risk-bearing entity like Equality Health allows you to participate in more advanced value-based contracts that previously were unavailable to you based on the size of the patient panel.

earnings; thus, we take risk on day one of the performance period. We do this because we understand that the practices need reliable revenue to do the additional work required to be successful in value-based care.

Q: You are a Family Practice physician.

How does a value-based care model impact you and your specialty?

A: The philosophy of Family Medicine embraces whole-person care that extends to the family and community. In this sense, family doctors, like other primary care providers believe that social determinants of health and equitable access to high quality care for all impacts the health outcomes for individuals and populations. The challenge is that a typical family practice does not have the resources required to meaningfully address all the needs of the patient and family. That is why Equality Health has committed to supporting the independent practices with free technology, education, staff training, and wrap around care coordination and in home services to support their patients they care for. ■

Q: Adopting a value-based care model requires

a financial risk, especially at the earliest stages of implementation. What were some of the financial burdens Equality Health faced as it moved towards value-based reimbursements?

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MARK R. STEPHAN, MD, MBA Chief Medical Officer Equality Health Dr. Stephan specializes in family practice medicine.

MStephan@equalityhealth.com

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