25 healthcare executives weigh in on their journeys in value-based care
To engage your providers in population health initiatives, show them the data and ensure frequent face-to-face interactions. Those were a couple of the key findings shared among 25 senior-level healthcare professionals who gathered in Chicago to discuss the future of care management.
The need for strategic alignment between provider organizations was cited as the top barrier to the industrywide adoption of population health. And a survey of the group identified transparency of performance data and frequent face-to-face meetings between physicians and non-physician leaders as the best ways to drive provider engagement.
Kevin Ban, MD, chief medical officer for athenahealth, led the hour-long roundtable discussion, which began with an overview of what healthcare providers today find both challenging and fruitful in their population health management endeavors. These initiatives include patient engagement, risk-based contracting and data-sharing.
"When I talk about population health management, this what I'm referring to," said Dr. Ban. "Population health is the iterative process of strategically and proactively managing clinical and financial opportunities to improve outcomes and patient engagement while also reducing costs."
Dr. Ban then posed poll questions to health system and hospital leaders, which they answered in real time. This provided participants with a glimpse into their peers' care management and value-based journeys. "This is a journey you're on, and you're ready for different things at different times," said Dr. Bann.
Before diving into the poll questions and the firsthand accounts and observations executives shared to support them, Dr. Ban first described his vision for what the future of care management may one day look like.
"I think we spend a lot of time thinking about the shiny bright object," he said. "People talk about precision medicine all the time. I am starting to think of precision medicine as a patient deeply connected to her care team, where they are able to understand her past medical history and what she wants for herself — what she can permit herself based on her living situation, her insurance — all these factors, together."
Here are five major findings from the poll questions posed to the 25 executives, who represented organizations based in 18 different states. Poll findings are accompanied by firsthand accounts from executives, who are attributed by their role, region and organization size.
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Finding No. 1
My organization is well aligned around a shared vision for population health.
- Strongly agree — 13 percent
- Moderately agree — 42 percent
- Neither agree one disagree — 21 percent
- Moderately disagree — 13 percent
- Strongly disagree — 13 percent
Firsthand accounts
"In the pediatric world, we haven't gotten there. We're starting to get our hands around some strategies — we've formed a clinically integrated network and have a shared savings agreement with Anthem, for instance. But that's more around our physician integration strategy than population health. We have a lot of things to catch up on — pediatric models are just eight to 10 years behind." — Vice president and CFO of a 155-bed children's hospital in the Midwest
"Our organization can't align with the board on when or how we are going to get out of the fee-for-service world. That's been going on for seven years, as lot of other organizations make large investments in [value-based care]. The issue is splitting the board, where some are saying, 'Let's ride out the fee-for-service world as much as we can and lag on making the investment.' I don't think that's the right view and neither does our C-suite, but it's hard to overcome that resistance to get the core investment we need." — CIO of a 137-bed hospital in the Midwest
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Finding No. 2
The greatest barrier to industrywide adoption of population health management is:
- The lack of strategic alignment between provider organizations — 39 percent
- The lack of a financial upside — 25 percent
- Capital investment requirements — 22 percent
- Lack of transparency into clinical, financial and operational performance — 9 percent
- Overly burdensome quality requirements — 0 percent
- Other — 4 percent
Firsthand accounts
"Before I arrived at the organization, we didn't employ a family practice physician. So there are a lot of independents in the fee-for-service world, who are not interested at all in any kind of population health discussion. We are actively trying to understand their concerns. Grinding out 30 to 40 patients a day is what it takes for them to have the quality of life they want, and slowing down — to them — means less revenue. But if you employ physicians, they see 15 to 25 patients a day and discuss how to improve patients' lives and keep them out of the [emergency room]. Right now it's too much about volume and not enough understanding of how [population health discussions] could help." — President and CEO of a 74-bed hospital in the Midwest
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Finding No. 3
What is the best way to ensure provider engagement?
- Ensure transparency of performance data — 33 percent
- Frequent face-to-face meetings between physicians and nonphysician leaders — 29 percent
- Delegate documentation work to nonprovider team members — 13 percent
- Reduce friction in navigating patients through the system — 8 percent
- Elevate physicians to leadership positions — 8 percent
- Strengthen provider social networks — 0 percent
- Other — 8 percent
Firsthand accounts
"We need to understand physicians' frustrations, their barriers and identify the decision-makers who can remove those barriers. When you have no forum to have that exchange, the dialogue is then missing, and that becomes even more concerning for them." — Senior vice president of diversity and inclusion for a 15-hospital system in the Midwest
"Our physicians document performance data, but they are on the same level with one another, so they don't really [compare or assess] the data. If I put performance data out there, they are not competitive in that way and they aren't looking at data they way I do. They realize this is a challenge and they are kind of working together, but they are not necessarily trying or wanting to rock the boat." — Chief information and revenue officer for a 387-bed community hospital in a major Midwestern city
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Finding No. 4
What is the biggest operational challenge to your population health strategy?
- Timely visibility into clinical and financial performance across the continuum — 25 percent
- Engaging patients — 17 percent
- Turning volumes of data into usable information — 17 percent
- Building or maintaining a value-oriented provider network — 13 percent
- Crafting effective partnerships — 13 percent
- Reducing clinical variation— 8 percent
- Other — 8 percent
Firsthand accounts
"Claims data lag was a huge issue — typically 90 days. We tried to align that with clinical data out of the practice management system, and it was problematic. Oftentimes we didn't have the relational database alignment that we needed for common identifiers. You are kind of guessing on a lot of patients. Counseling a physician 120 days after he or she has seen a patient, after an episode of care, is difficult. Physicians have a different memory or perception of what that entailed. Then the believability of the data goes down." — Senior vice president and pediatrician-in-chief with a 355-bed children's hospital in the Midwest
"Our patient population is older. I think our challenge is how to educate them about some of the technology they can use to be more engaged in their health. We try to bring them in and educate them, but they are not as familiar with getting texts on their smartphone to come to the clinic and follow up. We have brought on a specialist in patient engagement to figure out creative ways we can bring patients back in." — Chief information and revenue officer for a 387-bed community hospital in a major Midwestern city
"We send iPads home with our patients who receive care under bundled payments. It's done through our patient navigation program. We've found our older population love seeing their provider or navigator on an iPad; they feel we are taking special time to engage them. Our patient engagement has gone through the roof with a simple piece of technology. We use it as an advantage and promote it to the community." — President and CEO of a 74-bed hospital in the Midwest
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Finding No. 5
Do you believe the commercial market has caught up to Medicare with regard to risk-based contracts?
- Strongly agree — 21 percent
- Moderately agree — 50 percent
- Neither agree nor disagree — 4 percent
- Moderately disagree — 21 percent
- Strongly disagree — 4 percent
Firsthand accounts
"The Blues in our market — their idea of shared savings was the provider takes a big cut for three years and then they might see a payoff. We were kicked out of the Blue network for 10 months, which was very painful. Finally Blue Cross has come back, and three years later we have value-based contracts, and they are bragging about all their value-based contracts. Once it shifts and we teach the community about value-based care … it kind of flipped the market in that in order for these payers to compete now they all say they are value-based. I think it's an interesting thing, because the payers do want to hold on to every bit they can. They don't want to share anything. It's ugly." — Senior vice president and CFO of a 14-hospital system in the Midwest
"Insurers are trying to figure out how to provide value to employers, and they don't know how to do it. Employers figure out what their top costs are, so trying to do direct contracting arrangements with employers is almost better than with payers. Payers don't know how to size [non-commercial agreements] or how to do them across a broad market. They are not getting any underwriting gain from them, and the reason for them to strike these types of agreements has kind of gone away." — Vice president and CFO of a 155-bed children's hospital in the Midwest
The conversation was made possible by athenahealth, provider of medical record, revenue cycle, patient engagement, care coordination and population health services