Health system executives are increasingly viewing value-based care models as a way to improve their overall finances, which have been ravaged by COVID-19-related moratoriums on non-urgent care.
That's because "health systems no longer have the benefit of being reactive and relying on our case rates, presence and experience in the markets," said Mitu Ramgopal, national vice president of Lumeris. "We have to be innovative, and we have to think about building a more sustainable business model that's going to drive results in our new environment."
During a Nov. 12 session at Becker's CEO + CFO Virtual Event, Mr. Ramgopal joined Lumeris' Jeffrey Gleason, MD, national chief medical officer, in discussing how health systems can prepare to take on advanced risk-based contracts. The session was sponsored by Lumeris.
Five key takeaways they shared:
1. Master the basics. "When you really think about moving forward in value-based care, it's [about achieving] success in the fundamentals," Dr. Gleason said. "The first element is quality, gaps in care. The second is being able to effectively outreach to your patients — particularly your high-risk patients — so that you are seeing the right patient."
2. Optimize care management. "Not only do you have to enable [the provider] with the right data to know which patients they should be talking to, but you should also be empowering them with what [to] talk to them about," Mr. Ramgopal said. "If this is a polychronic patient [with] diabetes and high blood pressure, they may be living in an area where it's a food desert or they have transport issues. You have to be able to address that holistically. Otherwise, you're essentially creating a really expensive call center for the business, with really talented nurses outreaching to these patients but not necessarily [able to do] a whole lot with them."
3. Set reasonable expectations. "The easiest way to frustrate your providers and your care teams is setting goals that aren't reasonable for them to meet in the first year or the second year. We have to generate wins in order to generate results," Mr. Ramgopal said. "Oftentimes, there's a disconnect between what our managed care teams and our managed care executives are seeing and negotiating, and what our clinical and care teams are seeing and negotiating."
4. Align your metrics. "Organizations will have multiple contracts with multiple different metrics, and the next thing you know, you have 30, 40, 50 different metrics you're trying to perform against," Dr. Gleason said. "There's no possible way to succeed at 50 metrics. So, [be] thoughtful and [have] a strategy and a philosophy around how you choose your metrics, and which metrics you're willing to take from the payer."
5. Establish a strong network structure. "I often tell organizations ... that without a network governance model where we've organized the positions in a network, I can't get physicians to communicate all the different elements of what we're trying to achieve," Dr. Gleason said. "We organize around primary care, and we use that structure to not only guide education and dissemination of data for performance, but also to build future leaders. It is an opportunity to inform physicians and make them aware of what is going on in the system."
Click here to view a recording of the session.
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