Health system C-suites are thinking differently about growth and finding new ways to pursue the premium dollar as margins remain tight and care moves out of the hospital.
A recent report authored by Kaufman Hall leaders noted hospitals are expanding their key growth metrics beyond inpatient volume to include acquisition of covered lives, influence over how healthcare dollars are spent and the downstream impact on the total cost of care. Many large health systems are engaged in partnerships accelerating the shift to value-based care, and payer-provider affiliations dedicated to realizing value are among the most effective.
Phoenix-based Banner Health is a success story in developing a 1.2 million member health plan and partnering with an industry giant to form Banner | Aetna. The partnership includes 2,900+ primary care physicians, nearly 20,000 specialists, 38 hospitals and 172 urgent care centers.
Amy Perry, president and CEO of Banner Health, joined the "Becker's Healthcare Podcast" earlier this year and discussed the health system's growth plan, focus on community wellness and the advantages of a close payer-provider relationship.
"Healthcare costs, as we all know, are rising at an unsustainable rate and Banner has a health plan that has developed over 10 years. It creates the ability for us to have premium dollar and invest in health so we can actually have a bottom line where we're investing peoples' wellness," said Ms. Perry. "That is the end game for all of us wanting to lean into the care and coverage that we can at Banner. The attractive part is having the mission that's focused on people and then having the ability through the multiple components of Banner to deliver on that promise."
Banner is leaning into disease prevention and expanding access to care by adding physical locations, digital capabilities and wellness programs to better serve patients in a more sophisticated way.
"We want to provide our members with the ability to control their healthcare costs and with all the tools to stay well because that's what we're all in this for," she said. "Our industry is so skewed because of the way the revenue system works. We're all waiting for sick people so we can gain revenue, but in our triangle model, the way we really win in the future is keeping people well and having that premium dollar that could be invested in the kinds of things we believe our neighbors want and need."
Health systems with a comprehensive continuum of care will have the strategic advantage, Ms. Perry said, and she's committed to deepening the health system's reputation as a trusted partner for the community.
"That's the win for the next 10 years, and we're going to invest very heavily to make sure that happens," she said.
Other health systems are moving in that direction as well. In January, Anthony Aquilina, DO, executive vice president and chief physician executive at WellSpan Health in York, Pa., told Becker's he is focused on the future shift to value-based care is growing, especially in the government sector.
"We believe that we can succeed in a value-based world, but need value-based reimbursement models," said Dr. Aquilina. "With the significant challenges right now with Medicare Advantage plans, we are working to better understand how we are going to participate in the process and get closer to the premium dollar."
But not every health system has a health plan, and those without could be left behind. Doug Koekkoek, MD, chief physician and clinical executive at PeaceHealth in Vancouver, Wash., sees the tightening payer-provider relationships to manage the premium dollar as a disruptor.
"Those payer-provider entities can be expected to disrupt traditional referral pathways and instead move care to the lowest cost site-of-service in each market, resulting in both increased competition between delivery systems and potentially fragmented previously integrated delivery models," he said.
Omar Hasan, MD, chief quality officer of MaineHealth in Portland, sees payer-provider alignment pressuring those without the premium dollar to change.
"Market disruptions caused by payviders and other entrants in healthcare delivery, coupled with the increasingly unsustainable cross-subsidization of Medicare and Medicaid by commercial insurers is forcing integrated health systems to test and launch innovative delivery solutions," he said. "We are actively monitoring these developments and exploring options for competing with such disruptors in the markets that we serve."