Rapidly Changing Payer, Physician, and Hospital Value-Based Product Landscape Realities

Published Online: May 02, 2013
With healthcare change comes challenge, but change also creates opportunity. This year’s keynote general session for the NAMCP Spring Managed Care Forum was presented by Jacques Sokolov, MD, chairman and CEO, SSB Solutions, Inc, in Orlando, Florida. Dr Sokolov’s presentation, “Rapidly Changing Payer, Physician, and Hospital Value Based Product Landscape Realities,” provides several significant points.

Dr Sokolov said that clinical integrated organizations (CIOs), accountable care organizations (ACOs), and super CIOs are pivotal to the evolution of value-based products. This is due to the need for a shift from the traditional fee-for-service to a fee-for-value, including shared savings and bundles. “Shared savings” are for population health (eg, Medicare Shared Savings Program, ACOs), and “bundled payments” are for episodes of care (eg, surgical or procedure based care). According to Dr Sokolov, 90% of revenue today is fee-for-service, whereas within 5 years, it may transition to a 50/50 revenue share with fee-for-value. Value-based payment, including bundles and shared savings, will come together for chronic and acute care clinical model optimization.

Dr Sokolov stressed that value-based products and the ability to deliver those products must be on the provider and physician agendas. In fact, physician leadership and engagement is essential to CIO success. He said CIO value-based contracts allow for revenue streams above and beyond traditional delivery systems. Additionally, CIOs are designed to meet the clinical and business needs of physicians, hospitals, and payers. As a learning organization, they’re “more nimble than it’s less advanced provider competitors (eg, non-integrated hospitals) and most traditional health plans.”

CIOs are not an end point; rather Dr Sokolov argues that they are a stepping stone to more sophisticated care management. Value-based care evolution needs to be addressed, or payers and physicians may fall behind in the changing healthcare market. The bottom line, Dr Sokolov says, is that profound changes are ahead for all healthcare organizations.