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Preparing Medical Students for Value-Based Care

Kathleen Brooks

Tomorrow’s physicians start their medical training within the context of value-based care, unlike today’s physicians who are challenged to adapt to this growing value-based world.

Having finished my family medicine residency 33 years ago, I’ve practiced medicine during the HMO era, the fee for service era, and now the evolving accountable care organization era. I’ve had to adapt.

For a time early in my career I worked in a clinic where patients were largely uninsured, or on Medical Assistance before our state developed Medicaid managed care. Working with patients with very limited resources to choose tests and treatments and to obtain access to specialists for them brought me straight into the morass of health care costs, and was a compelling lesson in navigating value and fundamental shared decision-making with patients and families. Like all physicians of my era, I had little training or background to guide my decisions about cost and quality.

The University of Minnesota, as well as other leading medical schools across the country, is preparing medical students for this transformational change in care delivery.

Medical students today begin their education on value-based care in their first days of medical school. As they examine their cadavers and review the limited data accompanying them, the faculty begin the teaching process of asking “what do you see, how do you know, which tests would be necessary to confirm, why those tests…”

In our “Foundations of Critical Thinking” first year course, students work though clinical cases in small groups and practice developing patient problem lists, differential diagnoses, and initial treatment plans. Faculty and peers challenge choices, seeking value—where cost and quality are factored in. Students role model shared decision-making discussions with patients.

In these early months of their medical education, students bring to these discussions rich life experience in dealing with illness and medical crises of their friends and family and sometimes themselves. They know the complexity of our current health care system, and look to our curriculum to help them navigate it. From day one, we embed concepts of population health and quadruple aim* into their classes.

In my family medicine department’s residency programs, resident physicians learn about overservice bias with fee for service, underservice bias with capitation, and missservice bias with salary, as well as the benefits and burdens of pay for performance.

Today, we create frameworks to scaffold medical student and resident learning about value in health care. We understand that when our trainees finish their formal education, they must be prepared with the perspective, the knowledge and the tools to engage fully in our health systems as team members providing competent valuebased compassionate care.

* Quadruple aim: Triple Aim—enhancing patient experience, improving population health, and reducing costs—plus improving the work life of health care providers, including clinicians and staff.

Kathleen Brooks, MD, MBA, MPA, is a member of the Stratis Health Board of Directors. At the University of Minnesota Medical School, she is an associate professor in the Department of Family Medicine and Community Health and the former director of the Rural and Metro Physician Associate Programs.