Healthcare systems across the country are currently challenged to "bridge the gap" as the industry shifts from fee-for-service to pay-for-performance contracting, with many provider organizations carrying out both types of contracts simultaneously.
Operating in both worlds isn't easy, but for organizations like Orlando (Fla.) Health, holding steady in a fee-for-service footing is no longer an option; both patients and the community at large benefit when a broader view of care is taken, says Rachel M. Scheinberg, director of business development.
"We understand that our nation needs to shift the way it pays for healthcare and how it's delivered," she says. "We really are embracing this movement to fee-for-quality and the idea that doctors shouldn't just be paid for doing a service or doing multiple services, but for delivering high-quality outcomes."
To create value, Orlando Health is flexing its population health management muscles, adding care managers and investing in technology to help keep patients healthy and prevent the need for costly treatment. When treatment is needed, the system works to ensure it is provided in the most appropriate location, even if that means care is delivered outside the acute-care setting.
Investing in ambulatory care, patient outreach
"If we're going to be entering into contracts with employers or managed care organizations [based on value], it might actually be in our health system's best interests to have alternative sites of care, like ambulatory surgery centers," says Ms. Scheinberg, noting that while not all surgery can be done in an ASC, many less acute, uncomplicated cases can be performed in these settings at a lower cost.
Orlando Health currently holds a minority ownership stake in one ASC, and it recently partnered with United Surgical Partners International to develop additional centers in the market. "We see growing volumes happening at outpatient surgery centers," she says. "We want them to be in strategic locations for physicians and patients."
To prepare for population-based contracting, Orlando Health transitioned its primary care physician offices into National Committee for Quality Assurance Level III patient-centered medical homes. The health system has also entered into two managed-care, value-based contracts around primary care outcomes. These contracts are still paid on a fee-for-service basis, with bonuses for outcomes, at least for now. "We have a foot in two boats," Says Ms. Scheinberg. "This is a different way of delivering care. When doctors are able to get better results, they get a bonus. It's very clinically driven."
Care coordinators were hired for physician offices, and the health system invested in health IT tools to help providers identify and monitor patients at risk for health issues. Providers meet each morning to discuss patients coming in that day and those at home who need to be contacted. The PCMH very much focuses on providing care in a team-based environment.
What's interesting about patient outreach efforts, according to Ms. Scheinberg is that it doesn't involve reinventing the wheel. "Insurance companies have been doing this for years," she says. However, because patients didn't often have a relationship with the insurer, they were unlikely to answer the phone or take recommendations seriously. "Now, it's a nurse the patient has met and interacted with. It's not brand new, it's a matter of who is doing it," she says.
On the horizon: Patient-centered medical neighborhoods
In the future, Orlando Health plans to expand its contracts beyond primary care-focused PCMHs to what it has dubbed patient-centered medical neighborhoods. These broader networks would include affiliated providers, including specialists, ambulatory surgery centers and others who share patient information and coordinate care. The neighborhoods would help Orlando Health ensure "all of our caregivers are following evidence-based medicine protocols, and are connected to each other, and the patient," says Ms. Scheinberg.
For patients, the care they receive from an Orlando Health patient-centered medical neighborhood would be better coordinated, and the sharing of information would allow providers to more proactively engage patients in their care. It's this extra attention from providers that patients appreciate, which is critical as healthcare services are becoming more consumer-driven.
"It's those steps the patients do appreciate," says Ms. Scheinberg.