Four Provider Executives Share Their Thoughts on Succeeding In Value-Based Payer Partnerships

Evolent recently hosted a panel discussion at the CAPG Annual Conference titled Population Health and Managing Delegated Risk: Lessons Learned by Four Providers.

All of the participating panelists represent organizations that have taken bold and innovative steps towards realizing the goal of value-based care in their local communities, most recently through the Next Generation ACO partnership offered by CMS, which includes significant upside and downside risk. Some of these organizations also participate in value-based partnerships with commercial payers.

Panelists included David Joyner, CEO of Hill Physicians Medical Group; Dr. James Porter, Senior Executive VP of Deaconess Health System; Dr. Laura McGeorge, Medical Director of St. Luke’s ACO; and Don Halliwill, Executive VP and CFO of Carilion Clinic.

In case you weren’t able to make this session live, we’ve recapped the top 3 takeaways:

1. Value-based care is a long-term strategy – it’s okay to start small, but for a positive financial return on your investment, think big.
   While all the organizations featured on the panel are now participating in CMS’s latest Medicare shared savings program featuring upside and downside risk, this wasn’t their first foray into risk. They all started with lower-risk initiatives in order to gain the experience essential to building up a tolerance for risk and an understanding of what it takes to be successful in value. As Dr. McGeorge mentioned, St. Luke’s viewed their initial four years in MSSP Track 1 as “training wheels” for their care management program, and used that period to build robust post-acute care management that would set up them up for success in more aggressive models. They also used the time to hone their skills in quality – which eventually led to attaining their ACO quality score in the 92nd-percentile, helping them retain the stellar brand recognition required to keep patients within their network. Carilion Clinic followed a similar path in starting with MSSP Track 1, with the mindset that their transformation to a physician-led, value-based care delivery model would be a long-term strategy that would take time to pay off. After a few years of experience, Don Halliwill recognized that MSSP Track 1 would never quite get the organization to the return on investment they wanted. The realization that financial success of their investments in care delivery would require a “better deal” including the potential to retain more of the savings generated – and the desire to truly measure the effectiveness of those investments – led to the eventual decision to participate in a model with more upside and downside risk involved.
    
2. Physician engagement is critical but difficult to obtain. Overcome potential obstacles with creative thinking about the realities of your organization.
   As Dr. Porter shared, the notion of “get on board with these changes now, and if we eventually save money you’ll get a cut” might not work for every organization. Deaconess realized early on that another strategy would be required to entice their physician network – half of whom were employed, half affiliated – across 26 counties in three states. Instead, they funded a prospective incentive pool, with upfront financial incentives offered to providers for every time they adhered to agreed-upon protocol within the value-based care management plan. Providing tangible incentives at the very beginning was a great way to get momentum going, and physicians began taking a leadership role in moving the organization farther along on the value-based care continuum. Soon enough, providers were coming proactively to the health system to discuss issues that required support and collaboration. Making investments accordingly in areas of concern – such as palliative care – demonstrated that the health system was engaged in their involvement, and led to a much more productive relationship between the two entities. But again, getting to the point of that productive and fulfilling relationship can look different for different organizations. Dr. McGeorge referenced St. Luke’s comprehensive compensation redesign for all health system providers, aligning the financial model and incentives towards value-based care. At Carilion Clinic, Don Halliwill noted that there are physician leaders on the board of governors who are involved with approving the annual plan and budget, which has encouraged empowerment and accountability in the organization’s success.
    
3. To be more effective in the development of your own value-based care strategy, consider the rationale for payer decisions.
   David Joyner from Hill Physicians has worked on both the payer and the provider side of the health care equation, so he is uniquely positioned to share advice from the perspective of each group for the other to be more effective. His advice for providers? A reminder that much of the impetus for the decisions made by payers is due to pressure from employers, who “want it all – broad networks, high quality, and lower costs without making tradeoffs.” Awareness of that context makes the payer perspective easier to understand, and potentially compromise easier to reach. He also recommended that providers and payers need to move on from customized processes and preferences and adopt industry standard ways of approaching administrative efforts to cut costs and improve efficiency and consistency. Standardization “will benefit everyone.”  He also had interesting advice for payers. All parties agree the cost of care is unsustainable, so he advised getting past the secrecy that still cloaks costs in order to share full details with providers in regards to the costs of the care they’re delivering or recommending. It’s impossible for physicians to make cost-effective decisions without having a full understanding of the negotiated rates in a given market. All payers can and should directly contribute to continued and increased transparency around costs – a key component to the success of value-based care.

Interested in learning about opportunities to take on more risk within your market? Contact us at partner@evolenthealth.com.