Explore the inspiring journey of a doctor from Gujarat who rose to become a leading figure in value-based care in America. Discover insights on leadership, healthcare transformation, and the future of patient-centered care.
Introduction
Healthcare transformation isn't just about systems and policies, it's deeply personal. For Dr. Milan Patel, the journey from growing up in a government hospital complex in Gujarat to leading medical strategy for a 50-hospital system in the United States represents more than career progression. It embodies the evolution of healthcare itself, from volume-driven care to value-based outcomes, from fragmented services to holistic patient management.
Dr. Patel's unique perspective, shaped by his grandmother's dedication as a nurse and his own experience navigating two vastly different healthcare systems, offers invaluable insights into what works, what doesn't, and where American healthcare needs to go.
Dr. Patel's Healthcare Philosophy & VBC Challenges
The Foundation: Three Core Principles
Dr. Patel's approach was shaped by watching his grandmother—a nurse who raised three children alone while working in a government hospital—dedicate her life to patient care.
1. "Seva" (Service) Over Success Healthcare is a calling, not a career. Every metric and efficiency gain must view patients as human beings, not numbers.
2. Resourcefulness with Limited Resources Experience in India's resource-scarce government hospitals taught efficiency and stewardship—lessons that resonate in an American system wasting billions annually.
3. Families as Care Partners Indian healthcare culture treats families as integral to care. Dr. Patel conducts "family rounds" in U.S. ICUs, actively involving relatives in understanding disease and planning post-discharge care.
The Reality: Value-Based Care Transition Remains Incomplete
"We definitely are not there yet." The shift from fee-for-service requires a fundamental mindset change from "doing more to doing right"—a journey that's "choppy at best."
The Training Problem
Medical education still emphasizes diagnosis and episodic treatment over population health management and prevention. Doctors learn to treat disease, not prevent it; to manage acute episodes, not think like community physicians responsible for entire populations.
Five Systemic Barriers
Misaligned Incentives "Schizophrenic behavior" results when half the patients are fee-for-service while others are in bundled or full-risk models. Should you discharge quickly or keep them longer? It depends entirely on the payment model.
Inadequate Risk Adjustment Insufficient accounting for social determinants of health. A patient without transportation or medication funds carries the same risk profile as someone with full resources, despite dramatically different care trajectories.
Data Infrastructure Gaps Despite years of EHR investment, interoperability remains poor. Organizations can't easily share information, making whole-person care coordination extremely difficult.
Cultural Resistance Physicians aren't easily swayed from established practices. Changing ingrained behaviors takes time—the human element remains the slowest to evolve.
Volume-Based Legacy The traditional model rewarded more ED visits, admissions, and procedures. This infrastructure and mindset persist despite payment reform efforts.
Full-Risk Management: A Laboratory for Value-Based Care
The Employee Health Model: Perfect Alignment
Dr. Patel's health system manages full risk for its own employees across ~50 hospitals in multiple states. When employees get sick, the organization bears both healthcare costs and productivity losses—creating powerful natural incentives.
Three-Level Strategy
1. Robust Primary Care Investment Incentives for gym memberships, preventive visits, and BP monitoring. Focus extends beyond PCPs to pharmacy optimization, behavioral health, nutrition, and same-day appointments to prevent ED visits.
2. Comprehensive Hospital Care Management Care navigation, structured discharge planning, meticulous medication reconciliation, high-touch follow-up, and network steerage for quality care.
3. Retrospective Analytics Analyze where costs accumulate, which specialties employees seek outside the network, and which services warrant strategic investment. Consistent external usage signals gaps to fill or partnership opportunities.
This virtuous cycle—data analysis, strategic investment, continuous improvement—represents value-based care at its most effective, working only because incentives fully align.
AI & Predictive Analytics: From Buzzword to Bedside
Current Applications
AI-Enhanced Imaging: Identifies early strokes, saving critical treatment minutes.
Readmission Risk Scores: Epic's built-in tools combine prior admissions, ED visits, comorbidities, length of stay, medication adherence, and social determinants data.
Targeted Intervention Model
Rather than intensive discharge support for everyone (cost-prohibitive), the team identifies high-risk patients and focuses resources for maximum impact. While hospitalized, staff arrange:
- Social work and case management
- Pharmacy support
- Transportation vouchers
- Bedside medication delivery
- Pre-scheduled primary care appointments
ROI Example: High-risk COPD patients receive remote monitoring with home oxygen sensors, enabling early telehealth intervention. Cost: $1,000-$2,000 per patient. Benefit: Preventing one readmission saves $15,000-$20,000.
Success Factor: Seamless integration into clinician workflows that enhances rather than complicates care delivery.
Virtual Care Revolution: Augmentation, Not Replacement
The pandemic accelerated adoption dramatically—Dr. Patel's previous organization achieved its entire 10-year telehealth roadmap in one month.
Three Virtual Nursing Applications
1. Virtual Admission/Discharge Nurses Handle hour-long documentation burden remotely, freeing bedside nurses for direct patient care.
2. Virtual Specialty Nursing Enables knowledge transfer and supervision across geographic boundaries. Hospitals without specialized cardiac or ICU nurses access remote expert consultation and bedside supervision.
3. Virtual Sitters (Lowest-Hanging Fruit) Replace 10-15 nursing assistants who sit one-on-one with fall-risk or behavioral patients. Virtual monitoring covers multiple patients simultaneously. Companies staff these centers from locations like Costa Rica (no U.S. licensing required).
Cascading Benefits
For Nurses: Reduced documentation burden and burnout, more face-to-face patient time
For Patients: Faster response times, better education, more touchpoints
For Organizations: Increased capacity, reduced overtime, cost savings, improved outcomes
Critical Principle: Virtual care augments existing staff rather than replacing them, allowing everyone to work at the top of their license with human interactions focused where they matter most.
Beyond the Episode: Holistic Patient Management
One of Dr. Patel's most innovative approaches involves looking beyond the immediate reason for hospitalization to address underlying issues that often go ignored. This is particularly true for behavioral health and addiction, which carry stigma that prevents open discussion even as they drive the majority of readmissions.
His hospital proactively identifies mental health and addiction issues during every admission, regardless of the presenting problem. The goal is understanding the cascade of events that led to the acute episode. Was this heart failure exacerbation really about medication noncompliance driven by untreated depression? Did this diabetic crisis stem from addiction issues that prevent consistent self-care?
With a captive audience during hospitalization, the team arranges psychiatric consultations, connects patients with case management, and schedules outpatient behavioral health follow-up. Group therapy sessions help break down stigma while maintaining engagement after discharge.
New Jersey's Quality Incentive Program (NJQIP) for Medicaid populations provides financial incentives for addressing behavioral health, measuring whether issues are identified during hospitalization, whether patients are seen within 14 days post-discharge, and whether continuous care extends through 30 days. Hundreds of thousands to millions of dollars tie to these metrics, creating powerful motivation to do the right thing.
This program exemplifies proper risk adjustment: recognizing that social and behavioral factors dramatically impact outcomes, and paying providers accordingly when they address these complex needs.
Advice for Small Practices: Starting the Journey
Large health systems have advantages in data infrastructure, staffing, and resources that small practices lack. Yet the entire ecosystem is moving toward value-based care, so small practices need pathways to participate.
Dr. Patel offers several starting points. Joining an Accountable Care Organization (ACO) provides access to shared savings models and partial risk arrangements without requiring massive independent infrastructure. Working with insurance companies on HMO risk-sharing agreements offers another entry point where physicians share in savings when they manage costs effectively.
Some physicians are embracing concierge medicine models, limiting their panel to 200-300 patients instead of the typical 1,500-2,000. Charging annual fees of $1,000 or more, these practices provide wraparound services and 24/7 availability that enable true care management. Some insurance companies will even pay these fees, recognizing that accessible primary care physicians reduce downstream costs dramatically.
Remote patient monitoring and chronic care management programs offer proven, funded approaches that small practices can implement. Medicare already provides reimbursement, making these programs financially sustainable. The key is implementing them correctly, focusing on patient education and engagement rather than treating them as mere billing opportunities.
Rather than trying to disrupt healthcare's enormously complex value chain all at once, Dr. Patel advises tackling one process at a time. Incremental improvements in specific workflows create more sustainable transformation than attempting wholesale revolution.
Innovation Horizon: What’s Next in Healthcare
Practical Tech, Real Impact
Dr. Patel sees meaningful progress not in flashy breakthroughs but in simplifying everyday healthcare. AI for billing/coding and smarter deployment of chronic care and RPM can meaningfully reduce burden and improve patient outcomes—especially for smaller practices.
Reimagining Primary Care
Growing concierge-style models, whether funded by insurance or patients, offer consistent access to physicians—critical for effective population health under value-based care.
Progress Through Persistent Improvement
Healthcare transformation will come from coordinated advances across:
- Payment reform
- Technology and data integration
- Workflow redesign
- Cultural and educational change
Universal Lessons from India to the U.S.
Dr. Patel’s story demonstrates enduring principles:
- Service over success
- Resourcefulness with limitations
- Family engagement in care
These human-centered values support the global shift toward value-based care—despite ongoing challenges like misaligned incentives and data fragmentation.
Human Connection at the Core
Technology, AI, and virtual care are accelerators—not replacements—for compassionate, relational care. Improving healthcare starts with small, achievable actions: join an ACO, expand virtual care, adopt RPM, address behavioral health early.
Tradition + Innovation
Like choosing between Gujarati street food and a New Jersey diner—healthcare doesn’t need one answer. The best system blends:
- Innovation + empathy
- Efficiency + personal connection
- Modern tools + foundational values
Together, they create healthcare that is accessible, effective, and deeply human.