Reinventing Community-Based Healthcare Delivery in a Value-Based Landscape

The movement to community-based care had momentum even prior to the pandemic, but never has the opportunity for change been more primed than present day. At Chapters Health System, this change was really an expansion of the mission we’ve always served.

With the successful launch of our most recent program, Assurity High-Needs DCE, Chapters Health continues to redefine how community-based care is solving some of healthcare’s most complex cases. While our roots are in end-of-life, the real mission has always been a holistic, interdisciplinary approach to delivering the highest quality, lowest cost care in the ideal setting for patients and families. Given our exceptional track record for nearly 40 years in this space, it was only logical to extend that same innovative approach to holistic care and thereby solve many of the issues facing our fragmented healthcare delivery system today. As a result, Chapters Health has grown both horizontally and vertically, expanding service offerings and attracting new member organizations into its family of companies.

The concept is rather simple in nature, but the real feat is in execution. Cultural and operational underpinnings rooted in individualized care planning have perfectly set the stage to incorporate community health services, social determinants of health, and primary care in value-based designs. Using a matrixed approach incorporating home health, advanced illness management, telemedicine, social determinants of health, and primary care, we have been able to move chronic illness care further upstream, delivering the low-cost, high-quality experience that has for so long been the provenance of hospice to its patients, families, and communities.

By focusing on the unique care plan needs of each patient or the unique pain points of each payor or partner, Chapters Health employs solutions that bring maximal return while reducing waste and redundancies created when using the fragmented healthcare system at-large. Think of it this way, when you’re truly listening to the patient and what they really want, you avoid using or providing things they don’t want. That part is easy, right?  The value to our payors and partners lies in listening to them the same way. If their primary goal is member engagement, we customize our approach to meet that need. If their need is emergent care reduction, we build our response accordingly. Having a full continuum of services at our disposal is key. Without that, you’re forced as a payor to rely upon multiple organizations who almost certainly lack alignment of incentives and goals.

Organizationally speaking, having an owner’s mentality is key to making emerging payment models successful. The very premise of risk-based medicine is you do what is right for the patient, so the outcome is optimal and your success is too. There will likely be a great deal of individualization or customization as you expand your business, but having highly engaged team members, a strong company culture of care and accountability, and innovative spirit will be key as you look to bring your company along on the journey from traditional to emerging. It is also key to remember that it is a journey that is never complete. What was emerging last week is traditional next week. It’s always going to be a balancing act but that’s the fun part.

The most common question Chapters Health gets is: “How do we bring this sort of approach to our market? Where do we start?” The answer, while very straightforward, does require a great deal of organizational planning. Here are the top three strategies I would suggest:

  1. A clear definition of organizational goals: One can be anything, to anyone really. However, the steps to getting there are often complex and sophisticated. Having a very clear set of end goals in mind is critical.
  2. Define your build, buy, partner strategy: There are an exceptionally small number of organizations that have ownership of all the entities and capabilities needed to execute a plan of this nature. Having a full continuum – whether owned, managed, or partnered with – is key.
  3. Invest in communication: Having understanding and buy-in from all key stakeholders in the organization is paramount. You will be doing something very few others have done. It will lend itself to excitement and anticipation, but also confusion and potential hesitancy or fear. Managing that early on and assertively will be critical to maintaining the momentum needed for long-term change.

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