Transitioning from fee for service into value-based care has big challenges for health systems. But it doesn't have to become a monumental change.
John Herman, CEO of Penn Medicine Lancaster Health, is implementing value-based payments by thoughtfully integrating them into the system’s overall strategy, rather than through abrupt changes.
"Penn Medicine Lancaster Health sees value based payment as a complement to traditional fee-for-service models," said Mr. Herman. "We describe it as an 'and' strategy. Two key opportunities include the Medicare Shared Savings Program participation and direction to employer programs."
He said the most beneficial MSSP partnerships this year came from two consultants: Validate Health and Patient360. Validate Health guided the analysis of predicted performance delivering value-based care to track risk corridor and alignment methodology for next year. The health system decided to participate in the MSSP Enhanced Track.
The health system is also working with Patient360 to implement tools and processes across multiple EHRs for quickly quality reporting requirements outlined in the MSSP.
"We're also exploring how we can expand our DTE service's and self-insurance programs, and are partnering with consulting group Rule of Three to enhance our technical capabilities and local brokers and chambers to grow our employer customer base," said Mr. Herman.
Kevin Smith, CFO of St. Louis-based SSM Health, believes in the power of partnerships to improve healthcare and create value. SSM has a five-year partnership with Navvis, a Surround Care company, to create value-based care models supporting patients in managing their health.
"This work has resulted in proven best practices, tools, technology, and support services to accelerate the transition to value-based care, meaningfully engage and support physicians and clinicians, improve health equity, and help patients achieve their best health," said Mr. Smith.
The health system has developed an advanced care management platform integrated with its EHR, claims and other sources to address lifestyle risks patients can modify and help providers identify high-risk patients needing an intervention. The "one care team" approach is designed to make each patient visit more meaningful and facilitate physician peer-to-peer interaction.
"As a result, one in three SSM Health patients now receives virtual care management services, helping them better manage their health. At the same time, we are optimizing care models to control costs while supporting long-term well-being and management of chronic disease," said Mr. Smith. "This partnership continues to deliver benefits for both organizations and, most importantly, our patients – and we look forward to growing our impact over the coming year and beyond."
Arshad K. Rahmin, MD, chief medical officer and senior vice president of population health at Mount Sinai Health System in New York City, is also leaning into the "and" when it comes to value-based care. He is acutely aware of where partnerships can succeed, and where they fail.
"Value-based care excellence is a team sport that requires 'the village,' which includes targeted industry partners," he said. "The quality of the offering and partnership to execute are both highly important; key to this is the provider entity having clarity on what makes the most sense to partner, buy and build. A lack of clarity can sink almost any partnership."
So far, Dr. Rahmin said the data partnerships for skilled nursing facilities and post-acute care programs have been among the most essential in the value-based care transition.
"Key investments on the horizon include bi-directional data exchange (ie, point of care reminders and regular ingestion of clinical data related to [value-based care] performance metrics in structured and unstructured fields) with our community provider partners who sit on many different EMR, and specialty episode performance data," he said.