By Evereth Woodruff 
Welcome back to another episode of MedCity FemFwd, a podcast dedicated to discussing the breakthroughs and challenges in women’s health. In this episode, we’re joined by Dr. Keith Berkle, chair of Privia Women’s Health.
Berkle discusses the challenges OBGYNs face in transitioning to value-based care and the ways Privia is supporting women’s health providers.
Here is an AI-generated transcript of the episode.
Marissa: Welcome back to another episode of MedCity FemFwd. I’m Marissa Plescia, reporter for MedCity News. Value-based care is a hot topic in healthcare right now, but not always in the context of women’s health. That’s why in this episode, we’re joined by Dr. Keith Berkle, chair of Privia Women’s Health to discuss the need for value-based care models in women’s health and the ways Privia is supporting OBGYNs.
Hi, Dr. Berkle. Thanks so much for joining Med City FemFwd.
Dr. Berkle: Hey, um, Marissa, it’s nice to see you. Thank you very much for having me.
Marissa: Yeah, of course. Glad to have you. Um, so maybe just to start, um, maybe you could just tell us a little bit about your work and Privia Medical Group.
Dr. Berkle: Sure. I, well, I’m, I’m Keith Berkle.
I’m an O-B-G-Y-N in, in Richmond, Virginia. Um, my practice, Virginia Women’s Center is, is part of, uh, the, the Privia Medical Group’s Mid-Atlantic Market. Um, and since we’ve been involved, I’ve taken on some leadership roles with, with Privia as well. I, I chair our, our Mid-Atlantic Board of Governors and I chair our, um.
Our Privia Women’s Health, uh, board of Governors and our Privia Women’s health is a vertical of the medical group.
Marissa: Great. Thank you. And yeah. And when it comes to the women’s health providers that you work with, the OBGYNs, um, you know, what are some of the unique challenges that you feel they face, uh, when it comes to transitioning to value-based care compared to maybe some other providers?
Dr. Berkle: I, I, I think where we’ve, where we’ve stumbled just a little bit in value-based care in women’s health as a whole is, um, is, is that, that the. There, there’s not a really significant engagement, I feel like, that we get from, from the payers in, in helping us develop these programs. Right. In primary care. Just to, to draw that contrast in, in primary care, um, our, our PRI docs have been wildly successful in value-based care.
You know, value-based care is, is the, the idea is that we’re leveraging, um, outcomes for, for, uh, for prioritizing reward as, as opposed to just. Just quantity as opposed to just turn as many wrenches as you can. It’s really are, are we, are we able to, to prove and to show better outcomes? And, and that’s worth more money to the, to the payers.
It saves overall healthcare costs and that sort of thing. And in, and, and that system is well developed for, for primary care. And the, the payers and CMS have worked very hard on it in women’s health. It’s, um. It’s sort of been stapled on, uh, by, by the, uh, by the payers and, and by CMS. There’s, it is been hard to, um, to, to convince those organizations that there’s, that there’s, um, that there’s some really thoughtful and unique ways that we could, that we could execute, uh, value-based care in women’s health versus, um, the, the way that it gets executed in primary care.
Marissa: Yeah. Yeah. And so, in your mind, um. What, what does the ideal value-based model look like, um, at a women’s health practice?
Dr. Berkle: Well, so I, I think that, that it’s, um. Sorry, I’m gonna take a second to, to, to, to organize my thoughts around there. I, I think that, that the things that we need to be thinking about in, in value-based care for women’s health are, are a little different in primary care.
Um, one of the things is access, which is important across healthcare for sure. Um, but in ensuring that our, that our patients who, um. Who, who are, are pregnant or, or are trying to get pregnant or who even who have gynecologic issues and things like that, that those patients are able to make appointments with the doctor they need, when they need to see them, and that they’re able to make the appropriate follow up.
Pre pregnancy is a, a pretty limited. Period of time in, in someone’s life that we have to, to, to help them to, to really, really, uh, drive positive outcomes. And so access is critically important. Um, telling someone in primary care that they’ve gotta wait a month for an appointment is, is different than telling somebody who’s, you know, 18 weeks pregnant, that she’s gotta wait a month for an appointment when really she needs to be seen.
In, in the next few days. Um, so, so I think driving access is one of the things that we, that we do a really good job with in OB GYN. But that isn’t, um, isn’t necessarily part of the, the value-based programs that have, that have come through our, our commercial payers or, or through CMS. Um, so, so I think access is one.
Um, and, and I think frankly, reimbursement is the other, the, the, we, we’ve seen our colleagues in primary care, um. Uh, really be rewarded nicely for, for the, their success in, in achieving value in women’s health. We don’t see those same, those same rewards, and they’re, and they’re tied to metrics that don’t always make a lot of sense.
Um. In primary care they do. How’d you do on the A1C? How’d you do on the blood pressure? Right. Um, in women’s health it’s things like c-section rate, which there’s, there’s a huge amount of variability that that, that goes into that. It’s things like, um. How, how, how timely was the initiation of prenatal care?
Right. And so if a patient doesn’t come to us until 10 weeks, we don’t have any way of knowing that that patient was pregnant before that, before that 10 weeks. And, and, but, but the, the programs get dinged. And so the, the, the rewards for value-based care in, in OB GYN are, are really tied to metrics that are, that are, um.
That are not well thought out that I, I think that these, these, these commercial payers and, and CMS are, are thinking about, um, they, they’re thinking about the, the, the way that it works in primary care and trying to translate it. And it’s just a, it’s just an entirely different specialty. And, and, and these, these patients, these women deserve a, a really thoughtful, uh, way to ensure that in big groups like Privia Women’s Health, we have.
Put together a, a bunch of tools to make this really, really easy for our, for our docs to, to be successful in. Right? We’ve, we’ve leveraged technology to the hilt on top of our, of our EMR, which, which prioritizes ease of scheduling and ease of billing and all of that sort of thing. We’ve laid on top of that additional technology offerings that.
Bring the prenatal record right into view, right, sort of front and center for the provider, um, that, that has some decision support based on evidence that the doctor can use to, to make sure that for, for instance, this patient’s got gestational diabetes or she’s hypothyroid in pregnancy. We, we’ve got the tools that, that input all of that data right into the, to the chart so that, so that we can be sure we’re, we’re doing the right thing for this really, really diverse group of patients.
Um. We also have, have, uh, you know, spent some time working really heavily with, with another vendor who provides a, a patient facing education app that all of our, all of our patients have access to. Um, that gives them sort of week by week, uh, advice and education and instructions and pearls and things like that.
For their pregnancy, but through which we can also, um, perform remote patient monitoring, right? We can have our patients check their blood pressures at home and, and that information goes into that patient facing app, and it falls right into the prenatal record that, that is the EMR in front of our face.
And, and, and so we can know what’s going on with this patient, even if she lives 50 or 60 miles from our, from our office. We can make sure that. That we’re keeping a close eye on her health through all of that. And so we’ve, we’ve leveraged a lot of that technology to make sure that we can, um, that, that, that we can make as much a difference in, in these pregnancies as we can.
Um, but none, none, none of that is what kind of gets, gets, we get credit for in value-based care, we could credit on whether or not we did a c-section on somebody with breached twins. Right. That that’s, that’s a, that’s a black mark, which is, which is silly.
Marissa: Yeah. Yeah. Some really interesting, um, some, some really interesting comments there.
Um, I also, I, I, going off of that, I wanna ask you about the, um, women’s physician, um, at advocacy committee that Privia has. Um, can you talk a bit about what this committee is and why it was created?
Dr. Berkle: Sure. Uh, I’m, I’m happy to, um, my, my colleague, um, my colleagues, um, within Privia, um, uh, particularly Dr. Zia Kahn, Dr.
Sumi Sexton, Dr. Caitlyn Zaner, put together the women’s physician, uh, advocacy group. And, and, and this is a group that really looks at what are the challenges, women who are physicians, not, I’m a women’s health physician, but I’m, obviously, I’m not a physician who’s a woman. Physicians who are women face different challenges a a lot of times than physicians who are men, particularly physicians who are women who own their own practice and who maybe are the only provider in their practice.
Um, uh, and and I think that, that that group kind of coming together to, to look at those issues and think about how, how do we, how do we address some of this really? It, it sort of ties in nicely with our, with our Women’s Health mission. I, I don’t want to take credit for, for Dr. Kahan and Dr. Sexton and Dr.
Zander’s work, but, but I, I think that it’s a fantastic organization that they’ve, that they’ve put together to, to really look at that. I’ll, I’ll share with you if it’s okay, what we’ve learned in some of our, you know, from a pri women’s health standpoint, we’ve, we’ve looked a lot at, um. You know, equity among, among payments in different specialties and that sort of thing.
And, and what we’ve learned is that there, there really is a, a disparity in, um, sort of anatomically matched procedures that are performed on women that, versus those that are performed on men. So, so doctors that are operating on women, which by the way, I’m a minority and most OBGYNs in 2025 are, are women.
Um. But as a, as a specialty, we earn a percentage less than our colleagues in urology, in general surgery, and certainly in orthopedic surgery and other subspecialties like that. And, and, um. I think that that, that that speaks not only to sort of a, a legacy of, you know, of last a hundred years of, of valuing the, the care of women a little less.
But as, as we recognize now that the majority of the, of the physicians affected by this are, in fact women, there’s a, there’s an equity issue there as well. Um, so I think the Women’s Physician Advocacy Committee goes a long way towards, um, towards. Helping us put some tools together to, to address that with, um, with our commercial payers and with CMS and the, the ruck committee and, and all of the above.
Marissa: Yeah. Yeah. And you mentioned some of the tools that, um, Privia offers to support women’s health physicians. Can you go into a little bit more detail, um, on some of those specific tools?
Dr. Berkle: Sure. I, so we, we talked about the, the pregnancy tracking, the education app, um, that we’ve got to keep patients just kind of informed on what to expect to allow providers to share kind of this gestational age specific information with their patients.
Um, some of the other tools that we’ve put in place are, are, are some, some partnerships with, with several pro um, vendors that. Provide virtual care, um, for lactation support, right? For, for patients who are, who are thinking about breastfeeding after they deliver, or who have delivered and are in crisis mode in the middle of the night and, and can’t figure out what to do.
We’ve got virtual support, um, for those patients face-to-face support, right on their phone, right. We’ve got, um, we, we’ve got nutrition, uh, resources. We’re, we’re, we’ve put together some, some really healthy partnerships with registered dieticians who specialize in women’s health and who specialize frankly in, in prenatal nutrition and gestational diabetes.
That, that we’ve got, uh, that our patients all have access to. Um, through our platform and we’ve also partnered with, um, frame Fertility, who, who provides virtual fertility care. Um, there are a lot of of patients in that category, right? Um, for whom we don’t always have. Those of us who aren’t subspecialty trained in, in fertility, we don’t always have those answers.
And so being able to put. Those tools, fertility tools, lactation tools, nutrition tools in, in the hands of our, of our women’s health patients has been critically important, especially for, for patients that have, that have traditionally been. Had more trouble, I wouldn’t say denied, but have had more trouble accessing that kinda care.
Right. So particularly minorities and particularly Medicaid patients have, have frequently had a lot of trouble accessing that kind of care and, and we’re working to bring that to them to meet them where they are. Um, I. Our, I, I think our other, I, I think the, the biggest workhorse in our, in our sort of quiver is, is our, our EMR and the, the, the extensive work that we’ve done in, in optimizing it for the delivery, not only of prenatal care, but for gynecologic care.
Right. For, for assessing. Masses in the ovary and fallopian tubes, what we call ad nyl masses, right? For assessing heavy menstrual bleeding and who’s a candidate for which, you know, which, uh, intervention and, and how should we be thinking about that? Um, and, and certainly also. Privia has a, a large clinical research footprint.
And so as we, as we grow the ability of women’s health researchers to access the huge number of patients, um, pri Privia across the country, Privia takes care of about 5 million patients. Uh, uh. I’m not sure exactly how many of those are, are women’s health patients, but you would, you would guess around 50%.
Right. We, we’ve got a huge number of patients that, you know, may be eligible for some of this research. Who, who can really learn something from and, and who can be, you know, part of, of building their healthcare future by, by, uh, through, through clinical research.
Marissa: Yeah. Yeah. Interesting. So in the next three to five years, um, what are some things that you hope to achieve in the women’s health space, whether it’s with, um, the advocacy committee or, um, in working with these, uh, OB GYN providers in transitioning to value-based care?
Dr. Berkle: Well, a a couple of things fir, first of all, we’ve, we’ve gone a long way already towards developing a sort of a national women’s health platform that, that our, that our docs from across all of our markets are, are able to, to access and, and use to take good care of these, their patients. Uh, my, I I would very much love to, to grow that platform to lean in.
I, it’s. It’s hard to imagine. We’ve got something less than a perfect prenatal monitoring system right now, but I think there’s room to grow on that. I think we could get a little better in, in how we engage specialists, how we engage maternal fetal medicine specialists, how we engage neonatologists, pediatric cardiologists with all of that.
So I, I look for those. Um. Those associations with, with, uh, deeper subspecialties as we, as we continue to grow. Um, I, I think that I, I would really love to, to be able to, to have a. A better seat at the table for purview women’s health to have a better seat at the table with our commercial payer, um, you know, friends and, and also with, with our friends at, at CMS to really talk about what meaningful value-based care in women’s health looks like.
To, for, I, I would love to see value-based care in women’s health look like something other than, um, a side project that they let an intern take care of. Right. I, I want it to be something that they’ve, that they’re, that the. The, the folks that have figured out how to do value-based care in primary care, so effectively have a hand in, but I, I’d like for us to have a hand in it too.
I’d like for the Women’s Health Physicians to, to have some input in it. I’d, I’d like for our docs to help. Decide what, what that should look like, because I, I think we, I think we know, I think we take really exceptionally good care of patients and, and I think we can, um, we can grow that really, really effectively.
Tho those are a, a couple of the things as far as the Women’s Health Advocacy Committee goes, I am, I’m excited to see, to see that group continue to grow. I’m excited to use what they learned to, um, to, to help us make sure that we’re. We’re not only seeing e equity for, for our, our women physician colleagues who are, um, in other specialties, but that we see it for, for the women who are practicing OB GYN, um, because I, I think that they, they deserve it.
These are the hardest working people in show business in a, in a, a for, for, for an entire nine month pregnancy to pay about what a hip replacement plays pays is. Is, is a disservice, I think, not only to patients obviously, but to the, to the provider who, who pours their heart and soul into that, who delivers this baby at two o’clock in the morning, who, who works so hard with these patients to, to laugh with them and cry with them and, and make sure that they, that they have as healthy as experience as possible.
Marissa: Yeah, yeah. Very well said. Um, and going off of that, outside of Privia, what are some broader things you think the healthcare industry needs to do to advance value-based care models in women’s health?
Dr. Berkle: That that is a, that is a huge question, Marissa, and I’m, I’m happy to, to, to give it a shot. Right. I, I think that, um, I, I think that we have dialed in on, on how to, as, as a, as a healthcare system right on, on how to incentivize doctors, particularly in primary care.
We, we’ve sort of proven the concept in primary care. We, we’ve, we’ve dialed in on how to incentivize doctors. To really look at the metrics that matter and to, to make sure that they, that they’re providing relentless access to their patients. Right. And so I think, I think growing that and, and I think I, I don’t.
I’m, I’m not one of these folks who thinks we should completely get away from commercial payers and, and privatized healthcare and that sort of thing. I, I think all of that’s, I think all of that’s part of the system that we work in. Right. Um, but I think that, that helping these, these private payers also understand that, that.
That, that working towards better outcomes as opposed to working towards more volume and saving a buck is the, is the the best way to manage this. When we see our doctors work towards better outcomes, we see fewer emergency room visits. We see fewer ambulance calls, we see fewer untimely deaths, we see fewer extended hospitalizations because of complications, for instance, from diabetes or from end stage kidney disease.
Um, and, and I think that if we can. If we can convince our, our partners in, in the commercial payer world and, and convince CMS to continue, right? That, that aiming towards outcomes as opposed to aiming at at what, what your p and l looks like is, is gonna ultimately save healthcare dollars and, and hopefully not to be too dramatic.
Save healthcare in America, right? We, we’ve got kind of a bad rap.
Marissa: Very well said. Well, Dr. Burle, this has been such an interesting conversation. Thank you so much for joining. Dr. Berkle: Well, it’s been my pleasure. Thank you very much, Marissa. Anytime