On this episode of The Scope with Dr. K, Dr. Kosinski welcomes Dr. Mark McClellan, a leading voice in value-based care and director of the Duke-Margolis Center for Health Policy. Dr. McClellan, a physician and economist, shares his journey from medicine to policy, highlighting how he applies real-world evidence to healthcare reform, especially through innovative payment models. He explains the interdisciplinary work at the Duke-Margolis Center, which combines expertise from across Duke University to drive health policy reform and train future healthcare leaders.

The discussion centers on transitioning to value-based care by integrating primary and specialty care into a patient-centered model that emphasizes early intervention and high-quality, proactive care. Dr. McClellan highlights the importance of policy and financial alignment to support models like SonarMD, which aims to prevent costly complications in chronic disease management, particularly in gastroenterology. The recent Duke Margolis report identifies three specialty care models where bundled payments and risk-based approaches show promise—especially in nephrology and certain surgeries. However, gastroenterology requires more structured co-management with primary care to enhance cost-effectiveness and patient outcomes. With voluntary models slow to scale, CMS may adopt mandatory models in 2024, making standardization of outcome measures and financial incentives essential for success in GI value-based care.

Key Takeaways:

• Integration of Primary and Specialty Care: Achieving effective value-based care requires aligning primary and specialty providers, focusing on proactive care and early intervention, especially for chronic conditions like those managed by SonarMD.
• Need for Structured Co-Management in GI: Gastroenterology lags behind other specialties in adopting value-based models, highlighting the importance of coordinated, cost-effective care through integrated primary and GI provider partnerships.
• Push Toward Mandatory Models: As voluntary models face scaling challenges, CMS may move toward mandatory value-based care models for specialties in 2024, with standard outcome measures and financial incentives playing a crucial role in this transition.
• Financial Alignment and Policy Support: Success in value-based care depends on policy reforms and financial structures that incentivize long-term patient outcomes over fee-for-service models, with specific support for chronic disease management solutions like those SonarMD offers.

Quote:

“It’s very hard for specialists to manage a patient comprehensively without a strong primary care partner… But there’s not good financial support for enabling them to work together. Emerging models show promise, but we need to move payments for chronic conditions into person-level arrangements that support long-term patient tracking, diagnostics, and coordinated care.”