Global Healthcare Alliance shares 3 observations on the shift to value-based care

Despite CMS' move to cancel mandatory bundled payment initiatives for heart attacks, bypass surgeries and joint replacements, one Houston-based healthcare company has witnessed escalating interest and willingness from providers to discuss alternative payment models.

Global Healthcare Alliance manages value-based reimbursement programs for multiple clinical specialties on behalf of healthcare organizations across the U.S. The company was founded by Denton Cooley, MD, a cardiovascular surgeon and pioneer of cardiovascular payment bundles.

GHA Chief Development Officer James "Jamie" Dye and GHA CEO John Adams Jr. recently spoke with Becker's Hospital Review about their observations of the shift to value-based care.

Here are three insights from GHA's executives.

1. Providers still lack resources to implement value-based models

GHA says it sees healthcare organizations nationwide striving to be a leader in the market in terms of alternative payment models, but need assistance doing so.

The company recently established a partnership with the Hospital for Special Surgery in New York City. As part of the partnership, GHA helps administer the hospital's existing orthopedic and musculoskeletal bundled services contracts.

Mr. Adams says HSS had bundled programs with foreign embassies as well as commercial payers, but it was "at a point where they could no longer manually administer it." That's where his company stepped in.

He says GHA loads the hospital's contracts into GHA's system, which bundles fee-for-service claims into one case and sends it to the payer for reimbursement. Once the payer reimburses the claim, GHA divvies the payment between each provider in the episode.

2. Physician alignment and market share drive providers' interest in value-based care models

Mr. Adams says healthcare systems are veering away from buying specialty practices and looking for other physician alignment strategies.

"They feel like bundled pricing is a way to do that to bring in their non-affiliated physicians to give them some economic and clinical incentives to work with them in terms of their healthcare system strategy. And we found that to be the case as we travel as well," he adds.

The company contends the drivers of providers' interest or move toward value-based care are typically physician alignment and market share, meaning a second or third-tier market leader needs some competitive advantage to build programs and refocus.

3. Payers are also not prepared for valued-based care models

Mr. Adams says payers continue to lack capabilities to efficiently administer value-based reimbursements, and technological changes to streamline the process are lagging.

"Payers still make a lot of money through their employer plans … built around a fee-for-service model. They don't really want to move away from that until they figure their revenue stream out," Mr. Adams says. 

In terms of creating greater transparency between payers and providers, Mr. Dye says one aspect of GHA resonating with providers is its potential role as a neutral part of payer-provider negotiations. 

"We want to empower providers to have a level conversation with payers. That's probably a path of least resistance — to have those direct conversations with the analytical information we're able to provide." 

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