This blog post is authored by Nicholas Sauder, the 2022 intern in Dell Medical School’s Value-Based Health Care Summer Research Internship.
Attending medical school in the early 2020’s is a unique experience. The COVID-19 pandemic has brought focus on public health measures that could better address both current and future pandemics. Conversations about health equity have prompted reflection on how health care providers and systems must do more for underserved communities. Meanwhile, the generation of young women and men now in medical school are one of the demographics most in favor of a “Medicare for All” single-payer overhaul of the U.S. health care system.
As we continue these discussions, a critically important topic is value-based health care payment and practice reform. Value-based health care offers strategies and models that can advance health equity, public health and responsible health policy. In the summer of 2022, I was privileged to see this firsthand as a fellow in Dell Medical School’s Value-Based Health Care Summer Research Internship.
In Austin, the experience that best exemplified the positive impact of value-based health care was how UT Health Austin — Dell Med’s clinical practice — provided care for Medical Access Program patients. The Medical Access Program — or MAP — is a nonfederal health program for Travis County. MAP provides health coverage for uninsured individuals with incomes below 200% of the federal poverty level, regardless of their U.S. citizenship or residency status. MAP is specifically targeted at providing health coverage for lower-income individuals who do not meet eligibility requirements for Medicaid.
One limitation of MAP is that it has more limited funding since it is only a county-level program. The reimbursement that health care organizations receive for MAP patients is less than that of patients on private insurance or Medicare. This presents a dilemma for health care organizations. Well-meaning providers want to provide health care for MAP patients but often face financial challenges when doing so.
To address this, innovative, forward-thinking health care organizations need to step in, which is what UT Health Austin is doing. At UT Health Austin’s Musculoskeletal Institute, the interprofessional health care model helps ensure that, for example, MAP patients who can benefit from seeing a social worker immediately do so during their visit. At the institute, physician assistants and nurse practitioners lead many patient visits, which leverages staff expertise and reduces patient wait times. Finally, at the institute, bundled alternative payment models align incentives and goals for patients, providers and payors. This maximizes patient outcomes while minimizing unnecessary costs. Altogether, this unique value-based health care framework helps ensure that MAP patients receive superior or equal health care to any other patient.
Putting Value-Based Care in Practice
As the 2022 intern, I was able to see this vibrant system in action. Each week, half my time was spent in the clinic, where I recruited patients for health services and clinical research studies, and shadowed and assisted providers who engaged in individualized, patient-centered care. The other half of my time was spent completing research with Department of Surgery and Perioperative Care members Lauren Uhler, MPH, and Prakash Jayakumar, M.D., Ph.D. Under their direction, I investigated not only how value-based health care can deliver amazing health care to MAP patients, but also other fascinating topics such as how to implement artificial intelligence-enabled shared decision-making and the most comprehensive methodology to compute health care costs.
Ultimately, I am incredibly grateful for the experience I had in Austin with mentors such as Joanna Lopez, Lauren Uhler, Prakash Jayakumar, Kevin Bozic, Karl Koenig and David Ring. My key takeaway is the positive impact that value-based health care can have in advancing health equity, public health and responsible health policy. When advocates and policy makers introduce positive measures such as MAP, value-based health care plays an incredibly important role in successfully implementing the program and providing its benefits to patients.