Blazing the path of progress in value-based care

There is no one path to provider risk. Market dynamics, culture and history are among the elements that make each organization’s path unique. Providers that are transforming on the volume-to-value continuum all find themselves at various points in the process.

Paths to risk can be cautious. For example, hundreds of organizations, whether they are hospital-centric or provider-centric, have joined the Medicare Shared Savings Program (MSSP). The program offers flexible “tracks” that allow providers to determine the level of risk their organization can handle. But rather than go all-in as an MSSP, UHealth — The University of Miami Health System, chose to become a specialty provider to other Miami-based shared savings ACOs.

By following this process, UHealth believed it could better get the sense of coordination and integration needed to take on risk.

In preparing for risk, the organization worked closely with health plans on a fee-for-service basis, but tracked results as if they were bearing risk. Doing so helped them recognize the potholes ahead on their path to risk — as well as what it would take to smooth the way.

Paths to risk can be winding. Sure, everyone would like to take a direct path to risk, but it’s often best to take the path with the fewest obstacles. MyCare Chicago started out as a joint venture between 10 safety net hospitals and one behavioral health organization, with the intent of taking on the role of not only provider, but also payer.

MyCare Chicago leaders, however, didn’t feel the organization was ready to manage reserves, so they transferred their state contract to an insurance partner. The organization will work for the insurer care coordination and provider network management service provider. It’s a step toward full risk — one they needed to take to remain on the path.

Paths to risk require teamwork. It’s unlikely that an organization will flip a switch and move from 100 percent fee-for-service to 100 percent fee-for-value. It seems inevitable, therefore, that there may be some tension within systems that rely on both traditional revenue and risk-based revenue. USMD Health System of Irving, Texas, mitigates that natural tension by continually modifying compensation, incentives and other available measures to make sure they are aligned with their quality care and efficiency goals.

Even with less than 10 percent of the system revenue coming from risk-based sources, system leaders believe in the direction of fee-for-value is taking: focusing on high-quality, high-efficiency health care that puts the patient first.

For more details and in-depth perspectives of leaders from UHealth, MyCare Chicago and USMD Health System, check out the Fall 2015 edition of RISKMATTERS.


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