Photo: Jeff Lagasse/Healthcare Finance News
ORLANDO – Value-based care will continue to accelerate, and the best way forward for health systems, from both a financial and clinical quality standpoint, is to have a clear transition plan and a robust population health framework.
That was the message driven home by Dr. Nishant Anand, executive vice president and chief medical officer for Baycare Health System, at HIMSS22 in Orlando. Anand helped shepherd Baycare into the value-based world, to positive results.
Speaking during his session, “Prepare Your Health System for a Successful Journey to Value,” Anand said Baycare’s value-based journey has been successful largely through the use of evolving payment models, which allowed the health system to use value-based contracting toward a better population health model – one that’s also reliant on data, analytics, patient and provider engagement and care coordination.
The benefits to this are tangible, he said.
“Population health isn’t just one thing that you do,” said Anand. “Think about it as a balanced portfolio. In 2020, around March, utilization tanked to almost nothing. So if you get paid on a fee-for-service basis, that wasn’t great for your revenue. The people who were successful were the systems that had a value-based side. In terms of utilization, they were flat.”
Case in point is Florida, which has experienced at least five surges of the COVID-19 virus. Every time a wave came, fee-for-service entities suffered, while value-based organizations saw margin increases.
An organization shouldn’t move too quickly into the value-based world, he said, because that has the potential to disrupt profit margins. But the journey needs to happen. According to Anand, the Centers for Medicare and Medicaid Innovation believes the program has to transition to value by 2030 due to solvency issues.
One of the first steps for a healthcare organization is to decide which market segments to focus on. Anand suggests targeting traditional Medicare, Medicare Advantage, Medicaid and self-pay patients.
There are three competencies that need to be nailed down to be successful in these efforts: value-based contracting, establishing population health service organizations that leverage economies of scale, and networks.
All are important, but population health services organizations can centralize a system’s capabilities, said Anand, while networks can benefit from the presence and input of experienced clinicians.
“We focus a lot on engagement,” he said. “If people aren’t engaged they’re not going to respond to what you do. We always have this tendency in healthcare: If your network is too big, you want to make it smaller. If it’s too small, you want to make it bigger. Think about putting your most advanced physicians in the inner circle. And you need some people for network adequacy.”
Baycare’s population health model puts an emphasis on community resources such as Feeding Tampa Bay, which address the social determinant of food insecurity, thereby addressing one potential avenue of worsening health. The model also focuses on risk adjustments, and the system launched a Medicare Advantage plan in 2019 that’s ranked in the top 5% in the country, said Anand.
But a system can’t do everything at once, he advised.
“We look at quality,” he said. “We have pathways for colorectal screening, for mammography. We focus on risk adjustment coding. It’s imperative to do proper coding when you’re working with people on Medicare Advantage or the individual exchange. We also focus on end-of-life care and hospice care – if you can smoothly transition people, they’re so grateful.
“You can see value-based care is here,” said Anand. “It may seem like it’s slow-moving, but the trajectory is there.”