Value-Based Care Shifts into High Gear

Guideposts for the paths to participating in value-based healthcare models come into focus at a payment innovation summit held in Tennessee.

Although rural and disadvantaged communities are lagging behind, the shift to value-based healthcare delivery models is accelerating.

Gauging the movement of healthcare providers toward adoption of value-based contracting for their services and how to succeed in those contracts were the dominant themes for speakers at last week's National Payment Innovation Summit in Memphis, TN.

The conference, which I attended in the non-catered comfort of my home office in New Hampshire, was co-sponsored by the Healthcare Finance Management Association , Health Care Incentives Improvement Institute (HCI3), and Catalyst for Payment Reform.

With resource-rich health systems in urban areas leading the adoption of, and investment in, value-based clinical care and payment models, healthcare providers face high financial stakes, says David Krueger, MD, MBA, executive director and CMO of Bellin-ThedaCare Healthcare Partners.

Navigating the financial perils of redesigning care while simultaneously redesigning payment models is the key question at this stage in adoption of value-based healthcare, Krueger said during a general-session presentation at the payment summit.

"How do we move both at the same time in a way that we don't get hurt?" he says of the healthcare industry's value-based-care redesign high-wire act, with 1 million patient lives in the balance just at Bellin-ThedaCare.

The Wisconsin-based health system, which experienced a measure of success in Medicare's Pioneer ACO program, has been increasing its odds for positive financial performance in value-based payment models by climbing the learning curve as quickly as possible.

It started participating in Medicare-sponsored ACO contracts in 2012, and rose to the challenge of Pioneer ACO's double-sided risk. In 2012, the health system reduced per-beneficiary-per-year spending $389 for Pioneer ACO patients, Krueger says. The performance-benchmark-beating spending reductions could not be sustained, however and the average per-beneficiary spending cut between 2012 to 2013 was only $177.

From 2012 to 2014, in the Pioneer ACO and the Medicare Shared Savings Program, Bellin-ThedaCare posted impressive results, with high quality scores, low spending levels and shared-savings payments.

Although Bellin-ThedaCare joined several other founders in pulling out of the Pioneer ACO program, Krueger praised the program's role in advancing the health system's journey toward adoption of value-payment models. "It allowed us to put a program in place… it opened the doors."

Now, more than half of Bellin-ThedaCare's 1 million patients receive care through some form of value-based payment model, including Medicare Advantage and MSSP. The shift away from fee-for-service medicine includes a fundamental examination of healthcare services and redesign of care models, he says.

In value-based payment models, healthcare providers will have to revolutionize their patient engagement strategies, Krueger says. "How do we incent them down the path? We need to know when to get out of the way."

As an advanced pilgrim in the journey toward a more value-based healthcare industry, Bellin-ThedaCare is picking partners who are moving at a similar pace and running a similar leg of the race, he says, noting the health system's participation in Appleton, WI-based, AboutHealth.

The value-oriented collaboration features eight health systems, 48 hospitals and 8,000 physicians. "Incentives are built in, right down to the front line. All patients are viewed as part of the population," Krueger says.

'Inherent Mistrust in the System'
For healthcare providers, many lessons have already been learned in the transformation from FFS medicine to value-based care models, says Darin Gordon, director of TennCare and Tennessee's deputy commissioner of health care finance administration.  

A key lesson is the need for patience, the state Medicaid director says of efforts to transform care delivery and payment models simultaneously. "You can't do it overnight."

In recent years, healthcare payment and delivery reforms have been dominant elements of TennCare's administrative workload. Gordon says his experience reflects other state Medicaid leaders nationwide. "It has taken at least 50% of my time."

The necessity to pick the right partners is another key lesson learned in value-based care initiatives, he says. "Leveraging health plans has been critical."

Commercial insurance carriers have several areas of expertise that are well-suited to value-based care delivery and payment models. Areas ripe for "leveraging" include benefit and provider-network design, wellness programs, and preventive-health services, Gordon says.

With employer-sponsored insurance remaining overwhelmingly dominate in the health-coverage market, Gordon says commercial payers bring an essential partner to the value-based healthcare transformation table: large employers. The capability of large employers to provide "expertise in finding solutions has been vital," he says.

To successfully change the healthcare industry's dominant economic engine from FFS medicine to value-based payment models, a revolutionary change in mindsets will be required, Gordon says. The process of breaking down silos and linking crucial sources of information such as claims data and clinical data demands more than technological advancements in data management, he says, asserting that the process requires cooperation between longtime adversaries.

4 Ways Claims Data is Changing Care Delivery

"Historically, we have not done a good job partnering with providers as much as we should. [There has been] inherent mistrust in the system."

Equipping for Value-Based Healthcare Journey
Transformational change targeted at boosting value-based clinical service delivery is an essential element of the strategic vision at Cincinatti-based Mercy Health, says Amy Frankowski, MD, senior medical director for population health and medical director of the health system's ACO, Mercy Health Select.

Mercy Health Select features 1,800 physicians and has participated in MSSP since 2012. In 2014, Mercy Health Select posted the 10th highest MSSP shared-savings payment. At $6.5 million, the 2014 shared-savings payout was the highest among Ohio-based MSSP participants.

Financial alignment with payers is an important factor for healthcare providers to achieve success in value-based payment models, Frankowski says. And long-term contracts that include robust provisions for data sharing are essential to generate positive financial results. She lists the attributes of gainful data as timeliness, relevancy, transparency, accessibility and security. "Routine data sharing could not be more important."

Building productive relationships between healthcare providers and payers is crucial to making value-based payment models function effectively, Frankowski says. "You have to have trust and you have to be at the table."

She says contracting staff should be involved at every step of the process to "avoid surprises," and lists the key factors in building strong relationships between providers and as

• An early emphasis on cooperation between provider and payer clinical teams
• Specificity of language during fact-finding
• Contract negotiations, and sharing of data analytics capabilities

Gauging adoption speed of value-based care models
In the Friday afternoon session that closed the three-day payment innovation summit, Cristie Travis, CEO of Memphis Business Group on Health, said health systems in urban centers are leading the charge toward widespread adoption of value-based healthcare payment models.

But she said most physician practices in areas such as eastern Tennessee, western Texas and many other rural areas have yet to take their first steps toward participating in value-based payment models.

"I'm not really sure how many people are really all-in," Travis said. The disconnect" between the payment-reform summit attendees and the majority of physician practices across the country. "Most of the people out in the world don't think about this, ever!"