What are providers doing sustain a successful payer partnership? Here's a look at how Integrated Solutions Health Network and Fairview Health Services have taken the plunge:
1.Develop a vision
To transform payer relationships and the delivery of healthcare requires taking the long view. ISHN is developing its ACO as part of Mountain States Health Alliance, a 13-hospital system based in Johnson City, TN. Mountain States, developed a 10-year strategy plan to meet operational cost objectives, build its technology infrastructure, and enhance relationships to support a value-based business model.
2.Align to the Triple Aim
Mountain States uses a model that aligns aspects of the Triple Aim with measureable components. Affordability includes total cost of care, utilization, and pharmacy services; patient satisfaction includes access to care, safety, and customer service; health outcomes includes managing health risks, case managers, and living with illness. "This really is our guide is implementing our 10-year plan," explains Slattery.
3.Establish/redesign relationships with payer partners
Shifting a payer relationship from volume (fee-for-service) to a value-based model is risky. Fairview Health Services, a seven-hospital system in Minneapolis, began small about 10 years ago. Its first risk contract was a shared risk Medicare Advantage contract with UCare, a non-profit health plan.
In 2009 Fairview began a commercial ACO contract with Medica, the second largest health plan in its market. Fairview Health joined the Pioneer ACO program in 2012. That same year it began setting up new relationships with health plans that involve limited network products.