At the Becker's Hospital Review 5th Annual Meeting in Chicago on May 15, industry experts discussed the best ideas for shared savings agreements.
Scott Saran, MD, MM, vice president and CMO of BlueCross BlueShield, CMO of Government Programs at Health Care Service Corporation; Paula L. Stillman, MD, MBA, Healthcare Consultant – Population Health and Care Management; and Michael Englehart, President of Advocate Physician Partners led the panel moderated by Scott Becker, JD, CPA, publisher of Becker's Healthcare and chairman of McGuireWoods healthcare department.
What works?
• Clinical integration. Advocate Healthcare, based in Illinois, has been clinically integrated for nearly a decade, and the health system entered into shared savings programs with BlueCross BlueShield and Medicare four years ago. "We are an overnight success 10 years in the making," said Mr. Englehart.
• Physician alignment. The majority of Advocate's physicians are independent, 70 percent, but they are aligned with the health system's interests. Through physician alignment, Advocate strives to offer payers and employers in the marketplace transparency. "I love Advocate because they are far-thinking and creative," said Dr. Saran. "We have to have a system that will move towards a lump sum payment rewarding quality."
What doesn't?
• Lack of risk sharing. "We are set up financially and structurally to be a risk-bearing entity," said Dr. Saran. "But, we want solid alignment. If the discussion focuses on shared savings, but there is no plan for shared risk, we are not interested." Providers and payers will find equal ground in benefits and risk in a successful shared savings program.
• Ignoring behavioral health. Patients with behavioral health issues are among the costliest patients to hospitals and health systems. "I have been very fortunate to see healthcare through the lens of provider and insurer. The most interesting challenge is how to manage the highest cost patients in a network," said Dr. Stillman. In the past, social issues have taken a back seat in healthcare, but as population health begins to play a key role in shared savings and risk high-risk patient management is paramount.
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