Introduction to Value-Based Care Innovation
Healthcare leaders and physicians from University Hospitals convened at an Institute for Value-Based Medicine® (IVBM) event held in Cleveland, Ohio, on October 23, 2025, to discuss groundbreaking advancements in value-based care and population health management. The conference emphasized critical chronic conditions including diabetes and chronic kidney disease (CKD), bringing together medical experts to share innovative strategies and solutions.
Led by program chairs Ian Neeland, MD, and Patrick Runnels, MD, MBA, the event featured comprehensive presentations on reducing postoperative hospitalization stays and demonstrating how fee-for-service resources and value-based care models can work synergistically to improve patient outcomes and overall healthcare delivery.
University Hospitals, hosting the event in collaboration with The American Journal of Managed Care®, introduced five Systems of Excellence (SOEs) designed to fundamentally reshape provider approaches to patient care. These systems target five major chronic conditions: CKD, diabetes, chronic obstructive pulmonary disease (COPD), heart failure, and hypertension. The conference particularly highlighted the diabetes and CKD systems through detailed presentations by their respective directors.
Addressing Value-Based Care in Patients With Diabetes
Understanding the Diabetes Crisis
Diabetes stands as the seventh leading cause of death in the United States, representing a significant public health challenge. University Hospitals, located in Ohio where diabetes diagnosis rates rank among the nation’s highest, provides care to thousands of patients with prediabetes and diabetes. Despite remarkable advancements in diabetes medications and treatment protocols, diabetes management outcomes remain suboptimal.
Betul Hatipoglu, MD, medical director of the Diabetes & Metabolic Care Center at University Hospitals Cleveland Medical Center, explained that improving overall health in patients with diabetes can reduce their risk of microvascular complications by 37%. Beyond microvascular complications, diabetes correlates with severe health consequences including kidney failure, kidney hemodialysis with hypertension, blindness, and nontraumatic below-knee amputation.
Systems of Excellence for Diabetes Management
Dr. Hatipoglu identified a critical endocrinologist shortage as the primary barrier to adequate diabetes management. She oversees diabetes care for approximately 4,000 patients, yet emphasized the staggering disparity: 37 million Americans have diabetes while only 6,500 adult endocrinologists practice nationwide.
“We’re already trying to work into population health this diabetes system of excellence, to redesign how we take care of diabetes in the ambulatory space,” Hatipoglu explained.
University Hospitals developed SOEs utilizing multispecialty collaboration to ensure adequate follow-up and management of patients with diabetes while alleviating physician burden caused by extreme physician-to-patient ratios. Patient care teams now include diabetes educators, primary care physicians, nurses, certified diabetes care and education specialists, and clinical pharmacists.
“Diabetes is a team effort. You cannot anymore, in this day and age, treat diabetes as a one-man show. It’s not going to work anymore,” Hatipoglu emphasized. “The patient goes in and sees the primary care physician and is then taken care of by the other team members, step by step, depending on what they need.”
The Missing Piece to Multispecialty Collaboration
Primary Care Physician Burden and Burnout
The University Hospitals SOEs aim to reduce both hospital admissions and readmissions while simultaneously decreasing primary care physician (PCP) burden. Sarah Lang, MD, director of the CKD SOE and practicing PCP, provided firsthand testimony regarding PCP burnout and the overwhelming demands on physicians in this specialty.
“A recent analysis said that in primary care—this is crazy—to effectively manage every metric and close every gap would require us to do 27 hours of work in a 24-hour day,” Lang revealed during her presentation.
Dr. Lang emphasized the stark PCP shortage compared to the patient population with CKD. Approximately one in seven American adults has CKD, yet 90% remain undiagnosed. Medicare beneficiaries with CKD account for a quarter of Medicare spending alone, making it a condition with the highest admission and readmission rates.
Pharmacists as Care Team Leaders
Within the SOE multidisciplinary collaboration framework, pharmacists fulfill a significant role in reducing physician burden and comanaging patient care. At University Hospitals, pharmacists possess authority to initiate, discontinue, adjust, and titrate medications; order laboratory tests; and prescribe medications under initial PCP referral.
“The goal is to provide continuity of care between the PCP, the pharmacist, and the specialty visits,” Lang stated.
Pharmacists at University Hospitals can meet with patients more frequently than PCPs, significantly reducing gaps in patient care and ensuring continuous medication management and patient education.
Reducing Hospitalization and Improving Quality Care
Enhanced Recovery After Surgery (ERAS) Program
University Hospitals implemented an innovative initiative targeting postoperative outcomes and reducing hospitalization length. Heather McFarland, DO, critical care anesthesiologist and system chief of the Anesthesia Value Network, manages the Enhanced Recovery After Surgery (ERAS) program.
ERAS incorporates 14 standardized guidelines across 111 service lines, adopted by 13 hospitals to date. With approximately 350 patients monthly enrolled in ERAS, the program achieves impressive outcomes: surgical site infection mean occurrence below 1%, and 30-day readmission rates not exceeding 20% in the past year, reaching a low of 12% in December 2024.
The program saves hospitals millions of dollars by “decreasing variation and improving standardization” while significantly improving patient outcomes.
Optimizing Length of Stay
Charles LoPresti, MD, system chief for hospital medicine at University Hospitals, discussed the delicate balance in hospitalization stays, emphasizing quality concerns with both excessively short and prolonged hospitalizations.
“From the time of admission to the time this patient is discharged, that is the sacred timeline when everything is functioning as it should,” LoPresti explained. “Something comes up, and now all of a sudden, we get thrown off of this timeline.”
Dr. LoPresti categorized discharge barriers into three categories: germane (optimal length of stay for quality care), intrinsic (extended stays due to physician practice variation), and extrinsic (system inefficiencies like poor communication or staffing issues).
By utilizing electronic health records and adhering to clinical practice guidelines, care teams can significantly shorten discharge delays, reducing hospitalization stays. University Hospitals implemented patient-centered rounds—scheduled meetings among physicians, bedside nurses, and patients—to address timely concerns and ensure coordinated communication.
Advancing Population Health: Key Insights
The IVBM event concluded with a comprehensive panel discussion featuring George Topalsky, MD, president of University Hospitals medical practices; Valerie Reese, MBA, vice president of population health; and Jordan Winter, MD, director of surgical services.
Panelists addressed University Hospitals’ ambitions to shift from reactive, sick-care models toward prevention and early intervention, while acknowledging tensions between population health initiatives and fee-for-service models.
“We are dependent, dare I say, addicted, to the demand for our services. In fact, our compensation is directly tied to our individual productivity,” Winters observed. “You get rewarded for unnecessary surgery; as long as you don’t get sued for it, you get rewarded for it. Until we figure out how to wean ourselves off this model and truly commit to change, there is going to be misalignment.”
Conclusion
Panelists concluded by acknowledging that advancing multispecialty collaboration in primary care requires substantial education, adaptability, and continuous alignment from both physicians and administrators.
“We’ve made a lot of progress by focusing on outcomes and building a culture of collaboration—explaining the whys and the hows, solving problems together,” Topalsky concluded. “It’s an ongoing journey, but as we continue to adapt, engage, and align around what truly matters, I’m confident we’ll keep moving forward.”
The conference demonstrated that successful value-based care transformation depends on systematic approaches, team-based care models, and sustained organizational commitment to improving patient outcomes while addressing healthcare workforce challenges.
