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Value-Based Care: The Nuts and Bolts

by Elizabeth Hofheinz, M.P.H., M.Ed., December 27, 2019

Silos are used for storage—as in the contents are stagnant. And stagnation, says Zeev Kain, M.D., M.B.A., Chancellor’s Professor at the University of California and Adjunct Professor at Yale University, has become a real problem in orthopedics.

Thus, there is silo breaking…and then there is silo breaking the Zeev Kain way.

Dr. Kain, founder of the largest conference on value-based care in orthopedics, thought so far out of the box that he just tossed it aside and started over. And the supremely innovative OVBC event was born.

Now in its fourth year, the event eschews theory for practicality, asking such fundamental questions as, “What does value mean to nurses and physicians and how does that differ from what it means to hospital CEOs?”

Dr. Kain: “While most conferences on value-based care are heavy on theory and economic models, the OVBC is a nuts and bolts ‘how to’ regarding the transition from inpatient to outpatient and from volume to value. The three tracks—clinical, operational, and financial—show participants how the triple aim and bundled payments affect their daily work missions as surgeons, nurses, and healthcare executives.”

And here’s where it gets REALLY interesting…

“When you attend AAOS, for example, you see surgeons. Go to the AAOE and you see executives; at the NAON you get nurses. But there is no crosstalk…nobody else knows what they know. The OVBC is one-third surgeons, one-third nurses, and one-third executives. Forty percent of OVBC attendees come as part of a team…and when a facility sends a team, we know there is an increased likelihood that they will return and implement what they have learned. And we mix people up. For example, orthopedic surgeons have to sit next to a nurse or executive…not another orthopedic surgeon.”

Asked about the impetus for the OVBC, Dr. Kain told OSN, “Over the years I have implemented enhanced recovery initiatives within orthopedics in many hospitals and in fact have published 60 papers on the topic. In doing so it was always evident that the initial challenge was segmentation. Take a hip surgery…you have about 51 people who are part of the procedure, but they don’t talk to each other. On top of that many of them are giving contradictory information to the patient…and they have separate cost centers. I started to think, ‘What if we could bring them all together in a meaningful way?’”

So he formed a nonprofit entity that is agnostic to specialty…all are welcome.

“On occasion, professional societies ask to partner with us, but we avoid this so as to maintain an open platform,” stated Dr. Kain.

So what does this event “look like” on the ground?

“Because many participants attend with a team, we are able to communicate with everyone in a uniform fashion. When they visit vendors, for example, they go as a team. One thing this does is avoid a situation where the orthopedic surgeon has to convince the CEO of the value of XYZ product—because they are examining it at the same time.”

Emphasizing the nuts and bolts aspects of the event, Dr. Kain stated, “We do not present the most recent articles in the literature…we teach people what to do when they get back to their practice on Monday morning.”

For example, participants will learn how to negotiate a contract in a way that they are not going to lose money. Dr. Kain: “Outpatient contracting is on the rise, so we have a panel that includes a lawyer, an insurance company representative, a hospital executive, and an orthopedic surgeon. Another panel addresses warranties on orthopedic procedures—what they are and how to do them.”

Also on the agenda:

-The affordability of innovation in orthopedic surgery

-How predictive analytics are changing orthopedics

Zeev Kain knows that you have to give people a reason to care. Dr. Kain stated, “Surgeons are typically tasked by CEOs to practice more value-based healthcare…to move from volume to value. And there are many orthopedic surgeons who think, ‘Why should we care?’ Many misunderstand that value-based care is an economic model that has not only financial aspects but operational and clinical aspects as well. Orthopedic surgeons need to know how to adjust their clinical practice in a way that is in sync with a CEO’s vision of value and volume.”

“Nurses have similar concerns as they are squeezed between the surgeons and the hospital administration. The latter may say, ‘I want you to do this’ but the surgeons don’t understand the value of what the CEO is requesting so the nurses just go with what the surgeon says. At our event, participants learn how to arrange the functioning of an OR and clinic in a way that dovetails with the volume to value principle. (How to optimize block time? How to improve the flow of patients in clinic? Etc.) CEOs have heard about various models at conferences, but they have never heard the perspectives of the doctors or nurses, so they don’t understand them.”

On track to welcome 500 people and 40 speakers, the next OVBC runs from February 28-March 1, 2020 in Newport Beach, California.

Dr. Kain’s overarching message about his anti-esoteric event? “The orthopedic space is moving at a lightning pace…come get up to speed with real-life orthopedics or be left behind”

For additional information on the OVBC, please visit:

Josh Sandberg

Josh Sandberg is the President and CEO of Ortho Spine Partners and sits on several company and industry related Boards. He also is the Creator and Editor of OrthoSpineNews.

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