Welcome again to a different episode of MedCity FemFwd, a podcast devoted to discussing the breakthroughs and challenges in ladies’s well being. On this episode, we’re joined by Dr. Keith Berkle, chair of Privia Ladies’s Well being.
Berkle discusses the challenges OBGYNs face in transitioning to value-based care and the methods Privia is supporting ladies’s well being suppliers.
Right here is an AI-generated transcript of the episode.
Marissa: Welcome again to a different episode of MedCity FemFwd. I’m Marissa Plescia, reporter for MedCity Information. Worth-based care is a scorching subject in healthcare proper now, however not all the time within the context of ladies’s well being. That’s why on this episode, we’re joined by Dr. Keith Berkle, chair of Privia Ladies’s Well being to debate the necessity for value-based care fashions in ladies’s well being and the methods Privia is supporting OBGYNs.
Hello, Dr. Berkle. Thanks a lot for becoming a member of Med Metropolis p Ford.
Dr. Berkle: Hey, um, Marissa, it’s good to see you. Thanks very a lot for having me.
Marissa: Yeah, after all. Glad to have you ever. Um, so possibly simply to start out, um, possibly you can simply inform us just a little bit about your work and Privia Medical Group.
Dr. Berkle: Positive. I, nicely, I’m, I’m Keith Berkle.
I’m an O-B-G-Y-N in, in Richmond, Virginia. Um, my observe, Virginia Ladies’s Middle is, is a part of, uh, the, the Privia Medical Group’s Mid-Atlantic Market. Um, and since we’ve been concerned, I’ve taken on some management roles with, with Privia as nicely. I, I chair our, our Mid-Atlantic Board of Governors and I chair our, um.
Our Privia Ladies’s Well being, uh, board of Governors and our Privia Ladies’s well being is a, is a vertical of the, of the medical group.
Marissa: Nice. Thanks. And yeah. And in terms of the ladies’s well being suppliers that you simply work with, the OBGYNs, um, you recognize, what are a few of the distinctive challenges that you simply really feel they face, uh, in terms of transitioning to value-based care in comparison with possibly another suppliers?
Dr. Berkle: I, I, I believe the place we’ve, the place we’ve stumbled just a bit bit in value-based care in ladies’s well being as an entire is, um, is, is that, that the. There, there’s not a very important engagement, I really feel like, that we get from, from the payers in, in serving to us develop these packages. Proper. In main care. Simply to, to attract that distinction in, in main care, um, our, our PRI docs have been wildly profitable in value-based care.
You recognize, value-based care is, is the, the thought is that we’re leveraging, um, outcomes for, for, uh, for prioritizing reward as, versus simply. Simply amount versus simply flip as many wrenches as you possibly can. It’s actually are, are we, can we, to show and to indicate higher outcomes? And, and that’s price more cash to the, to the payers.
It saves general healthcare prices and that kind of factor. And in, and, and that system is nicely developed for, for main care. And the, the payers and CMS have labored very exhausting on it in ladies’s well being. It’s, um. It’s kind of been stapled on, uh, by, by the, uh, by the payers and, and by CMS. There’s, it’s been exhausting to, um, to, to persuade these organizations that there’s, that there’s, um, that there’s some actually considerate and distinctive ways in which we might, that we might execute, uh, value-based care in ladies’s well being versus, um, the, the way in which that it will get executed in main care.
Marissa: Yeah. Yeah. And so, in your thoughts, um. What, what does the best value-based mannequin appear like, um, at a ladies’s well being observe?
Dr. Berkle: Properly, so I, I believe that, that it’s, um. Sorry, I’m gonna take a second to, to, to, to arrange my ideas round there. I, I believe that, that the issues that we should be fascinated about in, in value-based care for girls’s well being are, are just a little totally different in main care.
Um, one of many issues is entry, which is vital throughout healthcare for positive. Um, however in guaranteeing that our, that our sufferers who, um. Who, who’re, are pregnant or, or are attempting to get pregnant or who even who’ve gynecologic points and issues like that, that these sufferers are capable of make appointments with the physician they want, when they should see them, and that they’re capable of make the suitable comply with up.
Pre being pregnant is a, a fairly restricted. Time period in, in somebody’s life that we now have to, to, to assist them to, to essentially, actually, uh, drive constructive outcomes. And so entry is critically vital. Um, telling somebody in main care that they’ve gotta wait a month for an appointment is, is totally different than telling any person who’s, you recognize, 18 weeks pregnant, that she’s gotta wait a month for an appointment when actually she must be seen.
In, within the subsequent few days. Um, so, so I believe driving entry is likely one of the issues that we, that we do a very good job with in OB GYN. However that isn’t, um, isn’t essentially a part of the, the value-based packages which have, which have come by means of our, our business payers or, or by means of CMS. Um, so, so I believe entry is one.
Um, and, and I believe frankly, reimbursement is the opposite, the, the, we, we’ve seen our colleagues in main care, um. Uh, actually be rewarded properly for, for the, their success in, in reaching worth in ladies’s well being. We don’t see those self same, those self same rewards, they usually’re, they usually’re tied to metrics that don’t all the time make numerous sense.
Um. In main care they do. How’d you do on the A1C? How’d you do on the blood strain? Proper. Um, in ladies’s well being it’s issues like c-section fee, which there’s, there’s an enormous quantity of variability that that, that goes into that. It’s issues like, um. How, how, how well timed was the initiation of prenatal care?
Proper. And so if a affected person doesn’t come to us till 10 weeks, we don’t have any manner of realizing that that affected person was pregnant earlier than that, earlier than that 10 weeks. And, and, however, however the, the packages get dinged. And so the, the, the rewards for value-based care in, in OB GYN are, are actually tied to metrics which might be, which might be, um.
That aren’t nicely thought out that I, I believe that these, these, these business payers and, and CMS are, are fascinated about, um, they, they’re fascinated about the, the, the way in which that it really works in main care and making an attempt to translate it. And it’s only a, it’s simply a completely totally different specialty. And, and, and these, these sufferers, these ladies deserve a, a very considerate, uh, manner to make sure that in huge teams like Privia Ladies’s Well being, we now have.
Put collectively a, a bunch of instruments to make this actually, very easy for our, for our docs to, to achieve success in. Proper? We’ve, we’ve leveraged expertise to the hilt on prime of our, of our EMR, which, which prioritizes ease of scheduling and ease of billing and all of that kind of factor. We’ve laid on prime of that further expertise choices that.
Deliver the prenatal report proper into view, proper, kind of entrance and middle for the supplier, um, that, that has some determination assist primarily based on proof that the physician can use to, to ensure that for, as an example, this affected person’s received gestational diabetes or she’s hypothyroid in being pregnant. We, we’ve received the instruments that, that enter all of that knowledge proper into the, to the chart in order that, in order that we could be positive we’re, we’re doing the precise factor for this actually, actually numerous group of sufferers.
Um. We even have, have, uh, you recognize, spent a while working actually closely with, with one other vendor who gives a, a affected person dealing with training app that every one of our, all of our sufferers have entry to. Um, that offers them kind of week by week, uh, recommendation and training and directions and pearls and issues like that.
For his or her being pregnant, however by means of which we are able to additionally, um, carry out distant affected person monitoring, proper? We will have our sufferers test their blood pressures at residence and, and that info goes into that affected person dealing with app, and it falls proper into the prenatal report that, that’s the EMR in entrance of our face.
And, and, and so we are able to know what’s occurring with this affected person, even when she lives 50 or 60 miles from our, from our workplace. We will ensure that. That we’re protecting an in depth eye on her well being by means of all of that. And so we’ve, we’ve leveraged numerous that expertise to ensure that we are able to, um, that, that, that we are able to make as a lot a distinction in, in these pregnancies as we are able to.
Um, however none, none, none of that’s what sort of will get, will get, we get credit score for in value-based care, we might credit score on whether or not or not we did a c-section on any person with breached twins. Proper. That that’s, that’s a, that’s a black mark, which is, which is foolish.
Marissa: Yeah. Yeah. Some actually attention-grabbing, um, some, some actually attention-grabbing feedback there.
Um, I additionally, I, I, going off of that, I wanna ask you in regards to the, um, ladies’s doctor, um, at advocacy committee that Privia has. Um, are you able to discuss a bit about what this committee is and why it was created?
Dr. Berkle: Positive. Uh, I’m, I’m glad to, um, my, my colleague, um, my colleagues, um, inside Privia, um, uh, notably Dr. Zia Kahn, Dr.
Sumi Sexton, Dr. Caitlyn Zaner, put collectively the ladies’s doctor, uh, advocacy group. And, and, and it is a group that basically appears at what are the challenges, ladies who’re physicians, not, I’m a ladies’s well being doctor, however I’m, clearly, I’m not a doctor who’s a girl. Physicians who’re ladies face totally different challenges a numerous instances than physicians who’re males, notably physicians who’re ladies who personal their very own observe and who possibly are the one supplier of their observe.
Um, uh, and and I believe that, that that group form of coming collectively to, to have a look at these points and take into consideration how, how will we, how will we tackle a few of this actually? It, it kind of ties in properly with our, with our Ladies’s Well being mission. I, I don’t need to take credit score for, for Dr. Kahan and Dr. Sexton and Dr.
Zander’s work, however, however I, I believe that it’s a implausible group that they’ve, that they’ve put collectively to, to essentially have a look at that. I’ll, I’ll share with you if it’s okay, what we’ve discovered in a few of our, you recognize, from a pri ladies’s well being standpoint, we’ve, we’ve seemed rather a lot at, um. You recognize, fairness amongst, amongst funds in several specialties and that kind of factor.
And, and what we’ve discovered is that there, there actually is a, a disparity in, um, kind of anatomically matched procedures which might be carried out on ladies that, versus these which might be carried out on males. So, so docs which might be working on ladies, which by the way in which, I’m a minority and most OBGYNs in 2025 are, are ladies.
Um. However as a, as a specialty, we earn a proportion lower than our colleagues in urology, generally surgical procedure, and positively in orthopedic surgical procedure and different subspecialties like that. And, and, um. I believe that that, that that speaks not solely to kind of a, a legacy of, you recognize, of final 100 years of, of valuing the, the care of ladies rather less.
However as, as we acknowledge now that almost all of the, of the physicians affected by this are, in truth ladies, there’s a, there’s an fairness problem there as nicely. Um, so I believe the Ladies’s Doctor Advocacy Committee goes a good distance in the direction of, um, in the direction of. Serving to us put some instruments collectively to, to handle that with, um, with our business payers and with CMS and the, the ruck committee and, and the entire above.
Marissa: Yeah. Yeah. And also you talked about a few of the instruments that, um, Privia gives to assist ladies’s well being physicians. Are you able to go into just a little bit extra element, um, on a few of these particular instruments?
Dr. Berkle: Positive. I, so we, we talked in regards to the, the being pregnant monitoring, the training app, um, that we’ve received to maintain sufferers simply form of knowledgeable on what to anticipate to permit suppliers to share form of this gestational age particular info with their sufferers.
Um, a few of the different instruments that we’ve put in place are, are, are some, some partnerships with, with a number of professional um, distributors that. Present digital care, um, for lactation assist, proper? For, for sufferers who’re, who’re fascinated about breastfeeding after they ship, or who’ve delivered and are in disaster mode in the course of the night time and, and might’t work out what to do.
We’ve received digital assist, um, for these sufferers face-to-face assist, proper on their telephone, proper. We’ve received, um, we, we’ve received vitamin, uh, assets. We’re, we’re, we’ve put collectively some, some actually wholesome partnerships with registered dieticians who focus on ladies’s well being and who specialize frankly in, in prenatal vitamin and gestational diabetes.
That, that we’ve received, uh, that our sufferers all have entry to. Um, by means of our platform and we’ve additionally partnered with, um, body Fertility, who, who gives digital fertility care. Um, there are numerous of sufferers in that class, proper? Um, for whom we don’t all the time have. These of us who aren’t subspecialty skilled in, in fertility, we don’t all the time have these solutions.
And so with the ability to put. These instruments, fertility instruments, lactation instruments, vitamin instruments in, within the palms of our, of our ladies’s well being sufferers has been critically vital, particularly for, for sufferers which have, which have historically been. Had extra hassle, I wouldn’t say denied, however have had extra hassle accessing that kinda care.
Proper. So notably minorities and notably Medicaid sufferers have, have often had numerous hassle accessing that form of care and, and we’re working to deliver that to them to fulfill them the place they’re. Um, I. Our, I, I believe our different, I, I believe the, the largest workhorse in our, in our kind of quiver is, is our, our EMR and the, the, the in depth work that we’ve executed in, in optimizing it for the supply, not solely of prenatal care, however for gynecologic care.
Proper. For, for assessing. Plenty within the ovary and fallopian tubes, what we name advert nyl lots, proper? For assessing heavy menstrual bleeding and who’s a candidate for which, you recognize, which, uh, intervention and, and the way ought to we be fascinated about that? Um, and, and positively additionally. Privia has a, a big medical analysis footprint.
And in order we, as we develop the power of ladies’s well being researchers to entry the large variety of sufferers, um, pri Privia throughout the nation, Privia takes care of about 5 million sufferers. Uh, uh. I’m undecided precisely what number of of these are, are ladies’s well being sufferers, however you’d, you’d guess round 50%.
Proper. We, we’ve received an enormous variety of sufferers that, you recognize, could also be eligible for a few of this analysis. Who, who can actually be taught one thing from and, and who could be, you recognize, a part of, of constructing their healthcare future by, by, uh, by means of, by means of medical analysis.
Marissa: Yeah. Yeah. Attention-grabbing. So within the subsequent three to 5 years, um, what are some issues that you simply hope to attain within the ladies’s well being house, whether or not it’s with, um, the advocacy committee or, um, in working with these, uh, OB GYN suppliers in transitioning to value-based care?
Dr. Berkle: Properly, a a few issues fir, to begin with, we’ve, we’ve gone a good distance already in the direction of creating a kind of a nationwide ladies’s well being platform that, that our, that our docs from throughout all of our markets are, are capable of, to entry and, and use to take excellent care of those, their sufferers. Uh, my, I I’d very a lot like to, to develop that platform to lean in.
I, it’s. It’s exhausting to think about. We’ve received one thing lower than an ideal prenatal monitoring system proper now, however I believe there’s room to develop on that. I believe we might get just a little higher in, in how we have interaction specialists, how we have interaction maternal fetal medication specialists, how we have interaction neonatologists, pediatric cardiologists with all of that.
So I, I search for these. Um. These associations with, with, uh, deeper subspecialties as we, as we proceed to develop. Um, I, I believe that I, I’d actually like to, to have the ability to, to have a. A greater seat on the desk for purview ladies’s well being to have a greater seat on the desk with our business payer, um, you recognize, pals and, and likewise with, with our pals at, at CMS to essentially speak about what significant value-based care in ladies’s well being appears like.
To, for, I, I’d like to see value-based care in ladies’s well being appear like one thing aside from, um, a facet challenge that they let an intern deal with. Proper. I, I would like it to be one thing that they’ve, that they’re, that the. The, the parents which have discovered how you can do value-based care in main care, so successfully have a hand in, however I, I’d like for us to have a hand in it too.
I’d like for the Ladies’s Well being Physicians to, to have some enter in it. I’d, I’d like for our docs to assist. Resolve what, what that ought to appear like, as a result of I, I believe we, I believe we all know, I believe we take actually exceptionally excellent care of sufferers and, and I believe we are able to, um, we are able to develop that basically, actually successfully.
Tho these are a, a few the issues so far as the Ladies’s Well being Advocacy Committee goes, I’m, I’m excited to see, to see that group proceed to develop. I’m excited to make use of what they discovered to, um, to, to assist us ensure that we’re. We’re not solely seeing e fairness for, for our, our ladies doctor colleagues who’re, um, in different specialties, however that we see it for, for the ladies who’re training OB GYN, um, as a result of I, I believe that they, they deserve it.
These are the toughest working folks in present enterprise in a, in a, a for, for, for a whole 9 month being pregnant to pay about what a hip substitute performs pays is. Is, is a disservice, I believe, not solely to sufferers clearly, however to the, to the supplier who, who pours their coronary heart and soul into that, who delivers this child at two o’clock within the morning, who, who works so exhausting with these sufferers to, to snigger with them and cry with them and, and ensure that they, that they’ve as wholesome as expertise as potential.
Marissa: Yeah, yeah. Very nicely mentioned. Um, and going off of that, exterior of Privia, what are some broader belongings you assume the healthcare business must do to advance value-based care fashions in ladies’s well being?
Dr. Berkle: That that could be a, that could be a big query, Marissa, and I’m, I’m glad to, to, to offer it a shot. Proper. I, I believe that, um, I, I believe that we now have dialed in on, on how you can, as, as a, as a healthcare system proper on, on how you can incentivize docs, notably in main care.
We, we’ve kind of confirmed the idea in main care. We, we’ve, we’ve dialed in on how you can incentivize docs. To actually have a look at the metrics that matter and to, to ensure that they, that they’re offering relentless entry to their sufferers. Proper. And so I believe, I believe rising that and, and I believe I, I don’t.
I’m, I’m not one among these of us who thinks we should always utterly get away from business payers and, and privatized healthcare and that kind of factor. I, I believe all of that’s, I believe all of that’s a part of the system that we work in. Proper. Um, however I believe that, that serving to these, these non-public payers additionally perceive that, that.
That, that working in the direction of higher outcomes versus working in the direction of extra quantity and saving a buck is the, is the the easiest way to handle this. Once we see our docs work in the direction of higher outcomes, we see fewer emergency room visits. We see fewer ambulance calls, we see fewer premature deaths, we see fewer prolonged hospitalizations due to issues, as an example, from diabetes or from finish stage kidney illness.
Um, and, and I believe that if we are able to. If we are able to persuade our, our companions in, within the business payer world and, and persuade CMS to proceed, proper? That, that aiming in the direction of outcomes versus aiming at at what, what your p and l appears like is, is gonna in the end save healthcare {dollars} and, and hopefully to not be too dramatic.
Save healthcare in America, proper? We, we’ve received form of a nasty rap.
Marissa: Very nicely mentioned. Properly, Dr. Burle, this has been such an attention-grabbing dialog. Thanks a lot for becoming a member of. Dr. Berkle: Properly, it’s been my pleasure. Thanks very a lot, Marissa. Anytime
