Shared-Risk Strategies

In our December Intelligence Report on regulatory strategies, only 17% of leaders said their organization is fully prepared for the shift from fee-based payment to a shared-risk payment model, and while 48% say they are somewhat prepared, 36% acknowledge they are not prepared. 

What is your organization's strategic approach to this shift in payment models?

Deborah Zastocki, DMP, RN, FACHE
President and CEO
Chilton Hospital
Pompton Plains, NJ

From our perspective, clearly what one needs to do to switch from the fee-based payment to a share model requires the proverbial alignment of interests. 

We know you don't have to employ all physicians. That is a very costly model. One needs to have a repertoire of options for physicians. We have employed some of our physicians and with other physicians we have assisted with recruiting for their offices to meet community needs. We have also done things such as management services agreements where we have used them in the comanagement of an office practice.

People are adopting one of a couple of strategies. One would be the wait and see approach and then jump on the band wagon. Some others are like us and realize that the infrastructure that one needs to provide is not going to be as effective in our current models. So you have to be able to identify how are you going to be successful and, if it is not by yourself, then with whom and how. 

With physicians in particular and the challenges and changes they are experiencing it is very irresponsible and in some sense self-defeating to try to engage in a model that you don't know will be sustainable in the long run. To our physician colleagues it can be frustrating and impede collaboration. One of the things we all have to do is be flexible and adaptive as we go forward.

Ronald A. Paulus, MD
President and CEO
Mission Health,
Asheville, N.C.

We are focusing strategically on the building block components that an accountable entity would need to be successful and thrive under that revamped reimbursement paradigm.

First, we're establishing a comprehensive primary care network because we see that as the front door and the overall clinical managers of the population and their focuJohns on population health.

Part two of the strategy is to ensure we have appropriate specialist alignment so we can support that work. We have been pursuing a mixed model that includes traditional physician employment and also professional service arrangements and other nonemployment-based agreements where we can have aligned incentives from both the clinical and a patient experience standpoint.

The third thing we are focused on is developing core care management capabilities and ensuring our care management skills and focus extend beyond the walls of the hospital and into the ambulatory care arena.

Fourth, we're focusing on building data analytics and warehousing capabilities. That would include predictive modeling to understand our population and get our arms around managing it.

Last but not least, we're ensuring we have clinical data exchange and consumer engagement capabilities and focus. I don't see it as flipping a switch. We see this as a continuum where over the next three to five years we are going from where we are today to a full-fledged capability. It is something we are working on every day, every month, every quarter.

Susan L. Davis
RN, Ed D
President and CEO
Sacred Heart Health System,
Pensacola, Fla.
 

On building the infrastructure: We have the components of it: a multispecialty medical group, the acute care component, some extended care. What we don't have is the IT infrastructure to give us the data and the information that we need to prepare the organization to move forward in a risk-sharing environment. We are building it.

On the IT hurdle: IT is the biggest hurdle for us and I don't think we are alone. There are so many different platforms we are all on and having the right types of tools to overlay on top of those platforms to be able to understand the costs bases and the clinical care outcomes is just not an easy process to implement. There are not a lot of vendors out there who have a lot of experience with it. The availability of trained IT people is also a challenge.

On the implementation: What has to drive your organization is developing your strategy and implementing it so that you have confidence in your numbers. I don't think you would want to do this just because your competitor across town is ahead of you on the curve. You need to drive the process of getting the data, making sure there is credibility in the data you have and that you have a system that enables you to respond so that your health system isn't left in the dust.

Juan Serrano
Senior vice president, payer strategy and operations
Catholic Health Initiatives
Englewood, Colo.

We are making a concerted shift to changing our model from being hospital-centric to a clinically integrated model that involves our physician ambulatory services and our hospitals because clinical integration is an important precursor to realigning incentives. Throughout this year we will have significantly shifted our focus toward clinical integration.

Secondly, we have population health data management capabilities. We are using a couple of different solutions to support people who either are already at risk or if they came from some form of performance-based accountable risk.

We have brought on board underwriting and risk management operations that are building a bridge to span the structure from healthcare delivery to health plans. And we have capitation management infrastructure such that when we ask stakeholders in our health system to assume responsibility for pay-for-performance—that if we take a capitation rate or if we simply want to manage a risk pool for which they are accountable—we are able to monitor that performance and distribute payment or incentives accordingly.

We are already in a number of performance-based payment programs.

So, we are on a pace that coincides with the rate in which the industry is transforming. When we are presented with opportunities to evaluate a risk-based model we have the skills, the tools and the people with which to move into that space.