Dr. Anthony Tersigni: Collaboration and value are keys to reimagining care

In the United States, healthcare leaders and providers recognize that a gap still exists between the promise of consistently delivered personalized, coordinated care and the current patient experience. This understanding has challenged healthcare providers to reimagine the way we deliver care as we evolve from fee-for-service toward fee-for-value. Healthcare leaders must develop new muscle memory as we unite to achieve better, more affordable and more accessible healthcare.

At Ascension, improving the health of our communities is central to our mission of providing compassionate, personalized care to all, with special attention to persons living in poverty and those most vulnerable. By pursuing affordable, accessible healthcare and coordinating quality care across populations, we are challenging and asking ourselves whether appropriate incentives are being designed across the care continuum — from primary care to post-acute care. Through Ascension Care Management, a subsidiary of Ascension, we're working with providers, employers and payers to create customized models that provide person-centered care at a lower cost, while ensuring that clinical and financial incentives are aligned across stakeholders to drive performance.

Longstanding economic models are quickly transitioning to become population-based, where value is emphasized through risk-based pricing. We see three key elements to be successful in how and where we allocate resources: underwriting and processing risk, managing risk and financing risk. By designing and implementing our platforms to succeed in value-based payment arrangements, we can seek greater end-to-end clinical integration and collaboration to successfully manage the health and wellness of our communities. The more we streamline the process and integrate care from the hospital to post-acute to home, the better the outcomes for those we serve.

To change the behavior of clinicians in this environment, we understand that we must collaborate closely with them to achieve value-based goals. At Ascension, the dyad model — in which a clinical professional and an executive or administrative leader serve as equal partners supporting a strategic goal — has proven to be successful at shifting behavior among small and large units within our organization.

In the journey to value, we have focused efforts around three phases of healthcare transformation: person-centered care, consumer engagement and the science of prevention.

First, we are encouraging and empowering patients to become more active participants in understanding and managing their own health. The patient-physician relationship has proven to be paramount, and shared decision-making models are starting to gain traction, with patients involved in making longer-term decisions. If we want to deliver truly personalized and compassionate care, true to our mission, we must invite those we serve to guide us as we innovate and create new models of care. We need to create value for our patients, from their perspective and to meet their needs. We're moving from transactional and episodic encounters toward care thoughtfully managed over time. We cannot simply tell clinicians what they need to do better in creating value, nor can we create models focused solely on the patient.

Second, consumer activation and engagement will become a driving force in care delivery. Both health systems and individuals will shift from having limited financial consequences for poor health to achieving financial rewards and incentives for wellness. We also can expect to see consumers take advantage of available virtual health strategies to manage their health. We know that consumers are empowered with information and technology at their fingertips and they are coming to expect a seamless end-to-end experience when they visit a site of care. The retail-oriented environment of healthcare is now a reality, and access and convenience are critical to delivering personalized care.

Third, our ability to perform well in our shared savings and shared risk contracts not only optimizes resources, but also will lead to improved quality, including early interventions that prevent more serious conditions. Analytics and actionable data will drive performance and ultimately inform us on key opportunities to improve health and reduce healthcare costs through more effective care coordination.

We remain committed to service by aiming to move 75 percent of our business into value-based arrangements that focus on the Quadruple Aim, in the best interest of those we are privileged to serve. As healthcare providers and CMS continue to evolve, innovate and learn from implementation of value-based programs, it's important to focus on working with both providers and patients to incentivize efficiency and support value. Collaboration with subject-matter experts who understand the pieces is essential to managing the risk.

Efficient and effective value-based care will benefit us all and support our efforts to care for the whole person — body, mind and spirit.

Anthony R. Tersigni, EdD, FACHE, is president and CEO of St. Louis-based Ascension, the nation's largest non-profit health system.

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