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VA Leader Brian Westlake, PT, DPT, Cert MDT on how to impact total cost of care, what it means to control healthcare spending in a fixed budget and how primary care is crucial, outcomes-accountable care, and MSK triage in primary care.
After 25 years leading inside the Veterans Administration, Brian Westlake came away certain that future of the physical therapy profession depends on moving upstream, into the primary care team.
He saw it firsthand. As an executive overseeing a ~$400 million budget in the Bronx, Brian watched primary care teams do what fragmented, downstream care couldn't do. They keep budgets viable and get patients the right care as early as possible. He has a high conviction that this is a better model for PT and that it's the only way the profession secures its future, steps fully into its role in the healthcare system, and has a bigger impact on patients.
He starts off with the story of four patients, all sent to him for evaluations for shoulder pain. Two actually had a neck, not shoulder impairment, and some had already gotten injections and an MRI of the shoulder before anyone screened the spine. It's exactly the wasted downstream spend that earlier PT contact is built to prevent.
Dana, Alex, and Brian get into:
– Why PTs belong at the front of the system as the MSK triage point of contact
– The VA's PACT model, and why MSK should follow behavioral health into primary care
– Outcomes-accountable care and the IMC model (25% MSK cost reduction, at risk)
– The Choice Act and Mission Act, and how community-care spend exploded
– Telehealth that actually scales: e-consults, store-and-forward, video-to-home
– Why weak outcomes collection is the thing holding PT back
– Speaking the language payers reward: total cost of care and "days at home"
Brian's message to the profession: We've earned a seat in the broader healthcare arena, we underestimate our own impact, and we can't afford to wait. We have to demonstrate the impact we can have so it becomes the norm for primary care providers and patients alike.
Tune in for the rest of the conversation!
Chapters
- 00:09 — Introduction: Brian Westlake’s VA career and virtual PT practice
- 03:35 — What it means for physical therapy to move “upstream”
- 10:47 — The value of early MSK assessment in primary care
- 13:37 — Building primary-care teams with embedded PT support
- 17:23 — The need for standardized, outcomes-driven PT care
- 18:42 — Integrated MSK Care: accountability, outcomes, and lower downstream costs
- 23:17 — How the VA evolved: outpatient care, the Choice Act, and the Mission Act
- 29:56 — E-consults and telehealth as tools for access and triage
- 36:25 — Why outcomes data matters for PT’s future and AI
- 39:09 — Proving value through total cost of care
- 44:41 — The practical barriers facing independent practices
- 47:28 — Primary care as the path to innovation and scale
- 48:46 — Advocacy, interoperability, and avoiding professional stagnation
- 51:06 — Why Brian is optimistic about PT’s future
- 54:54 — Closing: start small, pilot partnerships, and move forward
Find the full transcript and Brian's Bio here. Follow Brian on Linked In.
About the show: Future Proof PT is a podcast for physical therapists, physical therapists assistants, and others who want to think beyond the clinic, about policy, payment, identity, and the future of the profession.
Hosts: Alex Bendersky and Dana Strauss
Want information on PT and OT reimbursement and opportunities in policy and advocacy? Read Dana's guest post series for OT Potential here: "How OTs and PTs Get Paid" and Therapy and Value-Based Care Models.
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