Covid As an Accelerant: On Value-based Care (Yes), On Telemedicine (Partly), on AI (Not So Much)

Improved medical management of acute respiratory disease and a shift toward value-based care will be two of the last effects of COVID-19 pandemic, according to Brent James, M.D., M.Stat.

“We are seeing the financial model shift,” James said in a video interview this past week with Managed Healthcare Executive®. “And if anything, Covid has accelerated the shift to provider-at-risk, pay for value, population health — all names for the same thing.”

James has been a leader in taking a systems approach to healthcare quality and patient safety t and became well known for his work in that area at Intermountain Healthcare in Salt Lake City. He is currently a clinical research professor at Stanford and has a number of other affiliations.

James was less sanguine about COVID-19 accelerating the use of artificial intelligence. “Relative to Covid changing the rate of change — accelerating it — I am a little bit skeptical that it will,” he said, while noting the overall future of AI and machine learning and keen interest that his Stanford colleagues have about those technologies.

James, echoing what others have said about value-based care and the pandemic, noted differing experience of primary care providers in some kind of capitated arrangements and those dependent on fee for service.

“If you are a primary care provider that was largely capitated or in some sort shared risk model, those practices did very well under Covid — they thrived.” Practices dependent on fee for service have experienced business failure or have been purchased, James observed.

Telemedicine comes in two basic varieties, in James’ taxonomy: patient-to-clinician and clinician-to-clinician with perhaps the patient participating. He sees the patient-to-clinician version being of limited, long-term importance. “The stuff that is happening, clinician to clinician, with the patient being part of the conversation—now that one is interesting. That is one to really look at. The reasons is that it affects so much more of the healthcare dollar.”

Others have noted that COVID-19 has increased understanding of acute respiratory distress syndrome, which also affects people pneumonia and flu, among other conditions Evidence developed during the pandemic has shown that the prone position seems to improve outcomes for ventilated patients. Clinicians have also have found that patients on ventilators do better with low tidal volumes— not forcing as much air into the lungs.