Value-Based Care: Filling Critical Gaps in Care and Clinician Leadership

The value-based care (VBC) model was conceived in the early 2000s in response to the spiraling healthcare costs and suboptimal health outcomes. Now sponsored by both commercial and government insurers, VBC models tie the dollars healthcare providers earn for their services to the results they deliver for their patients (i.e., quality, equity, and affordable care), thereby “holding providers more accountable for improving patient outcomes while also giving them greater flexibility to deliver the right care at the right time”.

Oak Street Health (OSH), a national network of more than 1,750 primary care centers for adult Medicare beneficiaries, has been at the forefront of the VBC movement — particularly with respect to underserved populations. Statistics show that inequality in access to care is associated with an increased likelihood of experiencing adverse health outcomes for non-white individuals with low income. By locating its VBC centers in communities with high uninsured rates and higher percentages of Black and Latino residents, OSH has built an impressive reputation for improving care and health outcomes in underserved areas.

What convinces me that OSH is indeed filling a critical gap in care? OSH’s Chief Medical Officer for VBC Strategy, Ali Khan, MD, MPP, recently reported findings of an internal analysis in which analysts cross-referenced select ZIP codes with the social deprivation index (SDI; a measure of neighborhood-level community disadvantage and its association with health outcomes and inequities). The higher the SDI, the greater the likelihood that lives are more disadvantaged relative to social determinants, access to care is limited, needs go unmet, and health outcomes suffer.

The analysis showed that compared with primary care centers operated by regional academic medical centers and private health systems, VBC-operated centers were far more likely to be in ZIP codes with higher SDIs; i.e., marginalized communities. Furthermore, VBC organizations’ presence in vulnerable neighborhoods “mirrors that of federally funded Health Resources and Services Administration centers, whose explicit purpose is to expand care to underserved populations.”

This is great news, but we have a chronic shortage of primary care providers in the U.S. – particularly clinicians who are equipped to succeed in an increasingly VBC environment. Just before the December holidays, I contacted Khan to get the scoop on OSH’s innovative Clinical Fellowship for Value-Based Care Leadership program.

According to Khan, it all started with Griffin Myers, MD, MBA, OSH’s co-founder and chief medical officer, who envisioned a fellowship that integrates traditional medical education with a master’s of business administration (MBA) in the context of a cross-discipline curriculum that advances VBC and leadership. The idea became reality in 2020 when OSH and the Kellogg School of Management at Northwestern University (Kellogg) collaboratively launched the fellowship, a 24-month program that is based in Chicago and is offered to recent residency (Internal Medicine and Primary Care/Family Medicine) or medical fellowship graduates and early-career physicians.

The fellowships are salaried positions (~$130,000), and the MBA is fully funded along with extramural expenses. The class (6-8 physicians) provides care at an OSH center 3 days a week, and spends 2 days a week working on high-priority projects in core rotations that include:

• Population health teams/interventions
• Clinical operations projects centered around high-quality practices
• Field leadership experience in team management and local initiatives
• Medical director mentorship

The program is customizable, culminating in an MBA from Kellogg and consideration for a leadership role with OSH. Khan says that the core faculty (i.e., mentors, sponsors and coaches) teach fellows how to appraise the literature and expose them to “the best of what’s out there” in terms of comparative health education and VBC leadership around the country.

At Jefferson, we’ve been on the journey to a modernized core curriculum for about 30 years, and we’re actually seeing some pockets of progress. I asked Khan’s opinion on who is making the most progress. “A few medical schools come to mind: for instance, Kaiser, Geisinger, University of Houston. Typically, they are schools that are unencumbered by generational biases to maintain the status quo – delivery systems that get it!” He noted that improvement comes at a cost: “about $100,000 to re-tool for the Kaiser Permanente culture created at its Oakland campus.”

Kudos to OSH for fulfilling the theoretical promise of VBC and, even more impressive, setting in motion a fellowship program to help close the gap in clinical know-how and future leadership for VBC. Like Khan, I hope that policymakers will continue to support VBC models that drive investment in under-resourced neighborhoods to reduce inequities – and that medical educators focus on replenishing the pipeline of primary care clinicians to serve in these areas.