Navigating Healthcare Transformation: Understanding the Power of Value-Based Care in Rheumatology

Navigating Healthcare Transformation: Understanding the Power of Value-Based Care in Rheumatology.

More recently, the adoption of value-based care in rheumatology has emerged as a promising approach to enhance patient outcomes, improve quality of care, and control healthcare costs. The application of value-based care principles in rheumatology has the potential to transform the management of these chronic conditions.

How do providers optimize the management of autoimmune and inflammatory diseases?

  1. Patient-Centered Care: Patients are active partners in their treatment plans. Physicians work closely with patients to set individualized goals, address concerns, and tailor treatment strategies to their unique needs.
  2. Outcomes Measurement: Healthcare providers monitor and track specific clinical outcomes, such as disease activity, pain levels, and functional status, to ensure that patients are achieving their treatment goals. Regular assessments help guide treatment adjustments.
  3. Shared Decision-Making: Physicians and patients collaborate to make informed treatment decisions. This shared decision-making process considers not only the clinical effectiveness of treatments but also the patient’s preferences, values, and lifestyle.
  4. Care Coordination: Effective communication and coordination among providers ensure that patients receive comprehensive and integrated care. This prevents fragmented care and promotes treatment continuity.

What are the true benefits of value-based care in rheumatology?

  1. Improved Patient Outcomes: By focusing on patient-specific goals and continuously monitoring outcomes, value-based care can lead to better disease control, reduced pain, and improved functionality for patients with rheumatic diseases.
  2. Enhanced Quality of Life: Value-based care emphasizes holistic care, addressing not only the physical aspects of the disease but also its emotional and social impacts. This approach can significantly improve a patient’s overall quality of life.
  3. Cost Efficiency: While initial investments may be needed for better care coordination and patient education, value-based care in rheumatology can lead to cost savings in the long run by reducing hospitalizations, emergency room visits, and the need for costly interventions.
  4. Preventive Care: Early intervention and proactive management are central to value-based care. Providers can identify and address potential complications and comorbidities associated with autoimmune diseases, reducing long-term healthcare costs.

While value-based care is promising for improving rheumatology care, several challenges must be addressed.

  1. Data Integration: Effective value-based care requires the integration of electronic health records (EHRs) and data analytics to track patient outcomes and support care coordination. Ensuring the interoperability of these systems is essential.
  2. Payment Models: Traditional fee-for-service reimbursement models may need to be restructured to align with value-based care principles. Alternative payment models should be reviewed.
  3. Patient Education: Empowering patients to actively participate in their care is crucial. Providers must invest in patient education and support to help individuals better manage their conditions.

Value-based care represents a paradigm shift in rheumatology, emphasizing quality, patient-centeredness, and cost-effectiveness. While its adoption requires overcoming various challenges, the benefits are undeniable. Patients receive better care, providers are rewarded for achieving positive outcomes, and costs are more effectively balanced out. As rheumatology care management continues to evolve, the integration of value-based care principles can contribute to better outcomes and a brighter future for patients with chronic diseases.

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Director of Affiliate Development

Eliot Appel

Eliot brings over 35 years of experience in all aspects of physician practice management, growth, and sustainability.

Having worked with some of the most successful rheumatology practices all over the country, he has played an integral role working directly with partnering practices to provide guidance on financial performance, human resources, EMR systems, the billing cycle, purchasing, compliance, practice expansion, succession planning, ancillary services, etc.

Eliot’s previous work experience and accomplishments include managing the growth and development of a national rheumatology practice in nearly 30 states. He was also the Executive Director of Gastro Health, P.L., a 40+ provider Gastroenterology practice based in South Miami and was instrumental in its start-up.

Prior to Gastro Health, Eliot was the Executive Director of South Florida ENT Associates, a 35+ provider group practice in Miami-Dade and Broward Counties. He has worked in the multi-specialty group setting as the Chief Financial Officer for the Florida Institute of Health and in his early career he gained CPA experience from Grant Thornton, a large, international C.P.A. firm.  Eliot earned his B.S. in Accounting from the University of Florida.

Chief Creative Officer

Victoria Giambattista

Vicky brings 15 years of marketing, branding and creative services to the healthcare space, beginning her career with agency experience and moving to medical device, surgical accreditation, and SaaS software organizations.

She has a proven track record of standing up marketing departments and building sustainable growth models within creative teams. She is well-versed in sales enablement, operations, client engagement and retention programs, along with tech stack development and optimization. Vicky’s efficient and effective strategies and tactics create workflows that save time and help streamline and shorten the sales cycle.

Outside of work, she enjoys watching historical documentaries, wine tasting and interior design.

President & Co-Founder

Mike chavez

Mike Chavez is a seasoned healthcare veteran and has played an integral role in the inception and development of national rheumatology provider networks, working with hundreds of care centers all over the United States.

He brings a wealth of knowledge on the growth and successful development of medical offices while also working with industry and pharma to support clinical initiatives, and strategic partnerships. Additionally, he leads our CIO Board Clinical Initiatives & Outcomes working with both pharma and physicians to develop new treatments, diagnostic tools, and pathways to deliver improved patient outcomes.

In 2020, Mike was nominated and awarded by the International Forum for Advancements in Healthcare as one of the “Top 100 Leaders in Healthcare” and the “Who’s Who Top Executives in America”.

In his free time, Mike enjoys mixed martial arts, Muay Thai, Jiu Jitsu, and spending time with his Frenchie, Nutella.

Director, Revenue Cycle Management

Leila Ballard

Leila Ballard is a seasoned healthcare business professional with over 30 years in roles ranging from Certified Medical Assistant to Practice Manager.

She has a bachelor’s degree in healthcare administration along with multiple certifications under her belt. Leila has worked as a consultant for the last two years in software system management within multiple specialties.

One of her most significant contributions to the rheumatology space is when she helped grow a single doctor practice to one of the largest rheumatology groups in the country. Leila is excited to shift her focus to achieving our clients’ practice and financial goals.

Leila lives in the low country of South Carolina with her husband and teenage son. She is a foodie and loves to travel.

CHIEF EXECUTIVE OFFICER

Ray Waldrup

As a 30-year veteran in healthcare, Ray Waldrup has a broad knowledge of all aspects of medical practices. He credits his early years of owning a medical billing and consulting company for his unique understanding of where monies are made and lost. He has successfully expanded medical practices in anesthesia and critical care to multiple locations and cities while personally recruiting providers.

In 2009, Ray joined a 4-doctor rheumatology practice with one location in Charleston, SC. After a few years, he formed what became the largest rheumatology practice in the country.

Ray has also revolutionized infusion suites by aggregating purchase volume and negotiating differential contracts others could not. He has helped significantly reduce physician burnout through a 4-day work week, while still increasing practice revenue. He’s most proud of the many physician friends he has made and how they recognize him for improving their quality of life.

In 2019, Ray led the formation of a rheumatology-specific GPO that quickly grew to over 300 members in 18 months. By 2021, he was leading a practice of 26 locations in 9 states with 65 physicians and over 300 employees. In his free time, he enjoys playing golf, pickleball, and boating in Naples, Florida.

CHIEF FINANCIAL OFFICER

SCOTT GILOMEN

Scott Gilomen brings over 25 years of executive management experience in the healthcare industry with a heavy focus on rheumatology and oncology. His primary areas of expertise include financial analysis, pharmaceutical and supply contracting, implementation of new ancillary services, direct management of revenue cycle, medical real estate acquisitions and oversight, physician and advanced practice provider hiring, and management of facilities and staff.

In 1996, Scott joined an oncology practice in Gastonia, NC as the Executive Director. That’s where he developed expansion plans and opened new clinics in multiple locations. He implemented patient care initiatives including chronic care management (CCM) and physician dispensing, technology initiatives including electronic health record (EHR) and patient self check-in.

Scott’s multi-faceted experience as a leader drew the attention of ION Solutions GPO Advisory Panel and was invited to serve in 2008. He collaborated with other panel members to review and advise pharmaceutical companies on current and proposed GPO contracts, patient assistance/access programs, and product launches.

Scott moved from oncology to rheumatology as CEO for a 15-provider group in 2019. Five months in, and despite great obstacles and unprecedented variables with COVID, Scott quickly pivoted to implementing telehealth in less than a week. The infusion suite never closed and patient care was maintained with little to no delay. Other implementations included patient self check-in, CCM, physician dispensing, new insurance verification and prior authorization systems, and clinical trials.

Outside of work Scott enjoys walking, swimming, gardening, golfing, and spending time with his family and pets.