The transition to value-based care remains a struggle for most healthcare organizations.
In a recent survey of health system executives, 42 percent reported feeling challenged by multiple aspects of the value-based journey, including the alignment of leadership and culture, coordinating investments to drive return on investment, and transforming their business and care delivery models.
Cincinnati-based TriHealth is ahead of most health systems in its journey to value. The six-hospital health system has spent the last several years preparing for a new world with a transformative strategy focused on better clinical and financial outcomes. From the top down, TriHealth is committed to moving the organization from a hospital-centric, transaction-oriented health system to a clinically-integrated population health enterprise, and, evolving from a fee-for-service payment model to one based on value.
In a recent webinar, TriHealth CFO Andrew DeVoe outlined his organization’s pioneering journey to value, which has required investments in people, processes and technology. TriHealth’s integrated approach has driven cultural changes, better-aligned incentives and optimized care delivery. So far, TriHealth’s efforts have allowed them to successfully transition at least half or 250,000 of their patients to performance-based health plans.
If your organization is struggling with the transition to value, consider some of the following “best practices” from TriHealth’s transformational journey.
Understand the trends
To set their organization on the right course, health system leaders must have a clear understanding of the changing industry landscape. For example, a growing number of employers are wanting to contract directly with providers, rather than through traditional payers. In addition, patients are being pushed to receive more services in ambulatory settings, where care can typically be delivered more efficiently and for a lower cost than in hospitals. Plus, the rise of consumerism means that patients are now shouldering a larger share of healthcare costs and often demanding alternative methods of care delivery that may be more convenient or less expensive, such as telehealth or after-hours care clinics.
Changing regulatory requirements, provider consolidation and vertical integration are also disrupting the status quo. To successfully navigate this evolving landscape, organizations must first evaluate what changes may be required to their infrastructure, culture and technology.
Understand your organization
As TriHealth began its population health enterprise transformation, leaders identified five performance domains that exemplify the TriHealth way of leading, serving and delivering care. Over the last two years, TriHealth has worked to improve performance across all five of these areas and to date has made remarkable progress. By identifying and rectifying organizational deficiencies, TriHealth is now better-prepared to address the heavy-lifting required to complete the value transformation.
For example, one focus was on improving team member engagement and leadership effectiveness. Another area was better quality and safety, including lower hospital-acquired infection rates and fewer 30-day readmissions. Better service, as measured by HCAHPS and CGCAHPS, was also a priority, as was improving operating margins. A final concern was growth, measured in terms of hospital admissions, RVUs performed, and the number of surgical procedures.
To date, TriHealth has made dramatic improvements in all five of these areas, resulting in a better workplace, better care delivery, improved population health and enhanced value. As evidence of this progress, TriHealth has achieved almost 92 percent of their value-based incentives in their 2017 contracts and have grown attributed lives by more than 25,000 from 2017 to 2018. This represents a 10 percent year-over-year increase as TriHealth worked to create better value for patients, employers and Medicare beneficiaries.
Understand when to partner
Despite a good deal of success transforming the organization, leaders were concerned that TriHealth lacked certain core competencies to effectively manage the payer functions that are inherent to value-based care models, including population health management, financial risk management and engaging and aligning physicians. TriHealth also believed that an experienced partner could them expedite the time to value and provide scale and flexibility to their efforts. To avoid any potential pot holes in their value-based journey, TriHealth aligned with an operating partner to help address any potential gaps in infrastructure, operating capabilities or expertise, and to drive adoption and performance across the organization.
Understand key success factors
Early in TriHealth’s population health journey, the organization established a comprehensive plan to transform its care delivery and business models and to maximize its return on investment. Along with its operating partner, TriHealth continues to follow an integrated approach to drive cultural change, align incentives and optimize care delivery.
Key elements of TriHealth’s successful approach include:
• Identifying opportunities and gaps after a baseline capabilities assessment
• Organizing network governance to guide efforts and identify clinical leaders
• Developing physician contracts that align organizational and provider incentives
• Designing care model programs that support better health outcomes, lower costs, improved patient experience and physician satisfaction
• Enabling actionable information and practice transformation with the right technology, data transparency seamless workflows
• Measuring performance on an ongoing basis and continuously update efforts to meet program objectives
The transition to value-based care is not an easy process for any organization. However, by following best practices and addressing gaps in expertise, a health system can successfully transform and become a high-performing population health services organization.
By Jeff Carroll, Executive Director of Health Plans at Lumeris