Perspectives from provider organizations transitioning to value-based care models

Organizations across the country are transitioning to value-based systems of care delivery and reimbursement at different speeds and with varying objectives. With the first half of 2015 bringing many major announcements from both commercial payers and the Centers for Medicare and Medicaid Services (CMS), the push toward value-based models seemed to have become the preferred industry response to the rising, unsustainable costs of health care.

A few provider organizations publicly acknowledged their current and increasing efforts to transform their own systems. Population health management (PHM) has become a key priority, especially considering that the market for PHM technology and services has been estimated at more than $40 billion within the next three years.

The corresponding pace of change for individual provider organizations has seemed slower than the media hype around value-based care. Our conversations with provider leaders across the country have shown us that leaders are paying attention to value-based care, and many are actively preparing and making investments in the transformation, but that every perspective and experience is truly different. Regardless of the type or size of an organization, each one is encountering a unique evolution of their own care model and performance measures to achieve the triple aim for their organizations and patient populations.

The latest edition of RISKMATTERS from Optum® features an interview with three leaders of three very different provider organizations at various points on the risk continuum. We inquired about their experience within their organizations in facing the transition toward risk.

John Sory, chief executive, regional alliance at UHealth — the University of Miami Health System, said his organization has been “actively planning to move into risk first with (their) large Medicare Advantage populations.”

Kathy DeVine, executive director of MyCare Chicago, an accountable care entity serving 56 zip codes in the Chicago area, said that her organization is performing “a bit of an ‘experiment’ in bringing together organizations of different sizes and economic clout to create the opportunity to take risk” for their Medicaid population. To do this, DeVine said her organization has made several adjustments. “We created a service agreement and became a delegate of the payer, contracting everyone in our network under them.”

One of the major adjustments of value-based contracting is the way in which payers and providers work together. Bryan Demarie, MD, medical director, senior care/population health management at USMD Health System in Irving, Texas, said that his organization has great relationships with its payers. Additionally, he notes that the relationship is different from what they had in the past. “We meet on a regular basis. For our gain-share contracts, we meet quarterly to compare performance to expectations,” Demarie said. “This performance review process is much more open and transparent, especially as we go to various degrees of risk.”

A common point brought up by many providers seems to come back to the pace of change. With leadership and physician buy-in secured, mapping a timeline and forming a comprehensive strategy is imperative to setting the right tempo for your organization. This pathway will guide the development of new payment contracts and the building of integrated provider networks that can more successfully prepare your organization to manage and meet the needs of your populations under value-based payment models.

As UHealth’s John Sory stated on the topic of preparing for risk, “I think most in my position have a sense that you’ve got to go slow to go fast. This is called risk for a reason.”

For more insights from these three leaders, check out the article “Value-based Realities” in the fall edition of RISKMATTERS.

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