Marching toward value-based care, healthcare professionals may be wary of the clinical and financial hazards along the path.
Five experts in the healthcare field discussed how their facilities are navigating this journey during a panel titled, "Clinical and Financial Hazards on the Road to Fee-for-Value," at Becker's Hospital Review 5th Annual CEO + CFO Roundtable in Chicago on Nov. 8, 2016.
The panelists included:
- Jennifer Vermeer, president and CEO of University of Iowa Health Alliance in Des Moines
- Mark Henrichs, assistant vice president of finance at University of Iowa Healthcare in Iowa City as well as CFO of University of Iowa Health Alliance
- Patrick McGill, MD, family physician, medical director for physician informatics and physician champion for patient care redesign at Community Health Network in Indianapolis
- Tina Arnold, director of finance at Community Health Network
- La Sheena Sutton, population health analyst at Community Health Network
Bearing risk
This isn't the first phase in history that the healthcare industry has encouraged providers to bear more risk and develop networks. But looking back to 1995, the panelists noted some stark industry differences between then and now.
"The biggest differential is the amount of data and the richness of the data that we now have to manage risk, and also CMS has given us the opportunity to transition risk," began Mr. Henrichs.
And with advanced technology, this data is "more patient-centered driven; it’s more customized," added Ms. Arnold.
Ms. Vermeer jumped in, noting the intensity of financial pressures weighing down stakeholders in the industry. Unlike the 90s, consumers are now very much at the table, bearing more costs in increased premiums.
"I think it's just changing some of the fundamental expectations of the value proposition across the whole healthcare spectrum," said Ms. Vermeer.
This time around, Ms. Vermeer has seen Medicare as a more aggressive player than commercial payers. While CMS offers different levels of participation and transparent methodologies, commercial payers allow providers to take more risk and move faster. Commercial payers often use proprietary tools, however, so Ms. Vermeer suggested greater alignment across all sectors in order to achieve industry transformation.
From the physician perspective, the conversation with the patient has evolved. Consumerism has changed the name of the game, with patients arriving to appointments with data.
"They know what your patient satisfaction scores are; they know what your health outcome scores are," said Dr. McGill.
Serve up more data?
The industry doesn't need more data, but rather instructions on how to leverage the mounds of collected data.
"Where do we start to actually change our clinical practices? And that's where the rubber hits the road, and that's really, really hard work," said Ms. Vermeer. "At this point if we had more data, I'm not really sure what we would do with it."
The next steps involve using this data to transform care processes to align with facilities' financial incentives.
Mr. Henrichs cautioned against jumping to clinical assumptions right at the outset of data analysis. Although it seems obvious opportunity may lie with high-risk patients, those patients require a lot of care coordination, for example. Additionally, high-risk populations are often already immersed in the system, so going down a level and bringing those medium-risk patients in will present opportunity.
Equipped with a range of data tools, Ms. Sutton's work now involves identifying which tool to use for which piece of data. Facilities must also strategize the best ways of delivering that data to the appropriate audiences and "ensuring that everyone is looking at the data the same way," she said.
Evolving behavior
Transitioning to a value-based world is tricky, especially when facilities still run under a fee-for-service model.
"We are trying not to boil the ocean," said Ms. Vermeer. "Concretely, what are the things we want to focus on, this year?" Instead of drowning in the data, she suggested facilities zone in on the fundamentals and core practices that will achieve the performance metrics.
To survive and thrive in an environment with the Medicare Access and CHIP Reauthorization Act, it's essential organizations ensure their physicians are on board.
Dr. McGill's organization focuses on breaking down MACRA into digestible terms for physicians, highlighting four pillars for primary care:
- Understanding the populations for which the facility is caring
- Successfully closing patients' gaps in care
- Addressing patients' risk acuity coding
- Handing patients off during care coordination
"From a culture change, we are also trying to balance the burnout…we're asking them to work smarter, not necessarily harder," said Dr. McGill. "It's an ongoing conversation."
Considering post-acute care, Ms. Vermeer said University of Iowa Health Alliance did not possess a strong relationship with these providers in the past. However, the tides of change have brought the two care sectors together.
"We're beginning by developing a network that is really just going to start a collaboration, begin to look at data together…and really just create a framework to talk to each other about problems that both sides see that need to be solved," said Ms. Vermeer.
Ultimately, navigating this transforming industry requires facilities to grasp their patient populations' needs; educate their providers on necessary steps to achieve quality metrics; and jumpstart the cultural shift to a value-based world.