The Exec: How SSM Health is Succeeding in Value-Based Care

For health systems, providing effective value-based care involves having foundational building blocks, this chief clinical officer says.

Stephanie Duggan, MD, the chief clinical officer of SSM Health, is passionate about value-based care.

Duggan became chief clinical officer of SSM in November 2023. Prior to joining SSM, Duggan served as president and CEO of Ascension Michigan for five years. Her leadership experience includes serving as CMO of Ascension Sacred Heart Hospital in Pensacola, Florida.

"I love value-based care because value-based care means we as a health system are doing our job for those in the communities we serve," Duggan says. "When we think about value-based care, it is about being there for the patients every time they need care. With value-based care, we get credit for being able to give care in a more efficient manner."

To be successful in value-based care, a health system must have "foundational building blocks" that support delivering high quality care at a relatively low cost, according to Duggan, who adds SSM has four of them.

"We have our data analytics integrated, so we can see and measure the differences we are making," Duggan says. "Secondly, our value-based payer contracting is designed to manage alternative payment models. Third, we have care management programs because you cannot just suddenly expect patients to manage themselves into better healthcare. Finally, we have optimized our physician enterprise—you need doctors who are willing to go on the value-based care journey."

SSM started with seven care management programs, and recently added care management programs for congestive heart failure and diabetes care. One of the original seven is an acute transition program, where the health system has specialists who are trained to help patients when they are going from the hospital to the home or a post-acute care facility.

"Good care doesn't end when you leave the hospital or leave the emergency department," Duggan says. "Having someone guide you through care transitions has a lasting impact on how you manage to deal with the stress of an acute illness."

Data shows the care management programs are having a positive effect. In 2022, the patients who had enrolled in one of SSM's care management programs had a 17.5% lower per-member-per-month cost in 2023.

"That accounts for an annualized savings of about $16.4 million," Duggan says. "That is telling us that what we are doing is working."

Stephanie Duggan, MD, is chief clinical officer of SSM Health. Photo courtesy of SSM Health.

Attaining sufficient scale is critical to providing effective value-based care, according to Duggan, who adds that it's difficult to find success with a smaller number of patients.

"We have more than doubled the number of patients who we have attributed to our medical group that are in alternative payment models," Duggan says. "We had about 300,000 lives in 2019. At the end of 2023, we had more than 600,000 lives."

To support value-based care, SSM has also focused on annual wellness visits with patients. According to Duggan, patients who have annual wellness visits have an opportunity to talk with a provider about what's going on in their lives.

"When we are providing value-based care, we want to know what health means for the patient," Duggan says. "As clinicians, if we do not ask that question, we will do cookie-cutter medicine as opposed to individualized care."

For health systems, reimbursement is the primary challenge in providing value-based care, according to Duggan.

"Generally, when you start on the value-based care journey, you are only sharing upside risk with payers. So if you save money, you make money," Duggan says. "But as you get better and move further along the journey, you take on downside risk as well. It gets harder to capitalize on savings. What I am hoping is that as the rest of the country embraces value-based care, reimbursement will catch up."

Limiting expenses is essential in managing downside risk, Duggan explains. For SSM Health, diabetes care is one of the highest expenses.

"We are looking at how we can improve management of these patients to spend less on rescue care and more on preventative care, which not only helps the patients feel better but also keeps them out of the hospital," Duggan says. "That is how you win in value-based care programs—you must continuously be improving and helping your patients be healthier."