How Intermountain's new company, Castell, aims to ease shift to value-based care

Salt Lake City-based Intermountain Healthcare has launched a new company focused on helping providers, payers, health systems and accountable care organizations navigate the shift from fee-for-service to value-based care.  

The new company, Castell, will offer tools and services based on models tested at Intermountain that can be used by other organizations. These include a value-based clinical care model at Intermountain called "reimagined primary care" as well as a technology and analytics platform, digital tools and access to Intermountain innovation and initiatives. 

Rajesh Shrestha, vice president and COO of community-based care at Intermountain, is the president and CEO of Castell.

Here Mr. Shrestha shares the reasoning behind launching Castell, discusses how the company will operate and offers his view of Castell moving forward.

Editor's note: Responses were lightly edited for length and clarity.

Question: What prompted the idea for Castell?

Rajesh Shrestha: Intermountain's been on a value-based care journey for a while now. We've recognized we're in two separate businesses — specialty-based care and community-based care. Specialty-based care is our acute care-focused facilities. Community-based care has a [partial] focus on keeping people well. So that split in recognizing we're in two separate businesses was about 18 months ago. As that evolved, we recognized we needed to develop a new care model, which we did [with] "reimagined primary care," and manage these at-risk patients in a much more value-based way. 

Then out of that was born, "Now that we have the right care model, what are the components that we need to put around it to make it even more effective?" And we said, "Communities are hurting. Providers are hurting. Let's put together a mechanism so we can benefit the community through helping providers." 

Question: How will the company work as far as general operations?

RS: The general operations revolves around the management of risk and helping providers. And it's not limited to providers. It's a vehicle for health systems. It's a vehicle for payers that want to partner with us. It's a vehicle for nontraditional companies such as technology companies or others that want to partner to help benefit providers and communities. It is around if a provider or health system needs a new model of care, we can help them develop it vs. [the organization] having to go out and subcontract. On top of that is providing them with tools that help them deliver more seamless care and expand patient experience. And we want to focus on the digital aspect of it. We believe that that, coupled with "reimagined primary care," is going to be paramount.

[Additionally], this will be one of the first times on a larger scale where Intermountain will digitize and productize its intellectual property and embed that — whether that's the clinic process, whether that's through technology, whether that's through care pathways — to now help other systems in other communities.

Q: What is the primary care model, and what makes it unique compared to other clinical models? 

RS: The traditional models that are used currently that deliver great results are not typically hospital systems. They're stand-alone entities that traditionally only take Medicare Advantage risk. Our product portfolio though, is much broader than what you would see traditionally in those companies that focus on managing risk in a medical group context. So, we've got, in our opinion, a much broader product capability. We're going to be close to 45,000 [people receiving care through "reimagined primary care"] by the end of the year and 100,000 lives next year. If you think about the Nevada market as well, we'll be at 150,000 lives in this new model, managing risk effectively by the end of next year. 

Intermountain has a long history of mental health integration, a long history of community-based care. We took a lot of the core concepts and lessons learned from 15, 20 years of developing these models, and we've formulated that into more refined care pathways and processes to take care of patients in a risk-based environment.

Question: What are the next steps for Castell?

RS: We've got product that's going to be available for affiliates now. We've got another phase that's going to be ready Jan. 1, 2020. And we expect to have a lot of partnerships with this model to help create even more value for communities, and we're looking forward to having that discussion. 


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