https://www.ajmc.com/conferences/whcc-2019/unlocking-innovation-in-valuebased-care
Unlocking Innovation in Value-Based Care

Jaime Rosenberg

During a World Health Care Congress 2019 panel discussion on unlocking innovation in value-based care, panel members offered a comprehensive look at what’s driving this shift toward value-based care, what works and what doesn’t, and where consolidation fits into the mix.

Patients are demanding value, explained Redonda Miller, MD, president of The Johns Hopkins Hospital, who credited the high out-of-pocket costs that patients are experiencing as a major driver of the shift toward value-based care. “They want to understand what they’re getting, what the outcomes are, and how much they’re paying for it.”

It’s also based on an understanding of what patients in the community want addressed in their healthcare. Miller recounted the results of the hospital’s community needs assessments, which ask patients in the community what value means to them. Whereas results 6 years ago brought forth priorities ranging from diabetes management to chronic disease management, the most recent assessment found an overwhelming desire for addressing social determinants of health, such as stable housing and employment, which has caused Johns Hopkins to change some of what it does, said Miller.

Based on these results, the hospital has taken several measures to meet these needs for the population. One way they have done this is purposely hiring entry-level staff from 7 targeted zip codes; they then partner with community organizations and career coaches to ensure these hires have the skills needed, offer flexible scheduling so they can attend school and get their degree, and ensure that there is room for growth. You can’t just bring them in; you have to help them grow and move up in the ranks, said Miller.

“Once we create a model where the profitability of wellness exceeds the profitability of sickness, that’s when we’ll actually make the full transition to value-based care,” said Craig E. Samitt, MD, president and chief executive officer of Blue Cross Blue Shield of Minnesota, as he shared his vision of a healthcare landscape that has completely transformed into a value-based system. “As we think about what we would do differently if we were uncapitated, we would take far better care of those with complex diseases, and I think that we would also focus on those of rising risk, not just high risk.”

There also needs to be practice imitation, he said. “Our industry is not challenged with a lack of innovation. Our industry is challenged with a lack of imitation. There’s very good examples of the right way to take care of patients…so how do we get every hospital and every physician practice to practice like the best one?”

Lastly, there would be more focus upstream, addressing the behavioral and social needs of a patient, such as mental health, he said. This means putting yourself in patients’ homes, communities, and lives to really understand the things driving downstream costs.

As the health system continues to work toward this vision, the panelists shared lessons learned that they’ve come across thus far.

Miller offered 2 cautionary tales, one being awareness of unintended consequences of payment policies. For example, she said, when implementing revenue caps, health systems have to make sure they are incentivizing getting rid of inappropriate avoidable utilization and not incentivizing cutting down on all utilization, thus restricting care. The second is the time horizon in this shift. When trying to make systematic change, like total cost of care for the Medicare population that incentivizes a focus on social and behavioral needs, there needs to be awareness that this will not change overnight; these shifts take years to come into fruition.

It’s also important to lead this shift with the doctors and leaders in the health system, which means ensuring that these doctors and leaders are on the same page, said Jason Mitchell, MD, chief medical and clinical transformation officer, Presbyterian Healthcare Services. If you have leaders in your organization who are not bought into this shift, it won’t work, he said.

Meanwhile, Samitt said that the healthcare industry should mirror tactics of other industries and think more transformatively rather than incrementally. For example, as we think about the change from a service and affordability standpoint, the healthcare industry should be more like Costco, and when thinking about evolution and membership, the industry should be more like Netflix.

Wrapping up the session, the panelists discussed whether consolidation in the market is helping or hindering the shift toward value-base care. According to Mitchell, consolidation can have positive implications because there’s a certain scalability needed to be able to invest in the technology and tools needed to drive value. Miller added that there’s more alignment and less variation through consolidation, as well as more synergy due to shared electronic medical record systems, for example.

While this consolidation can offer coinvestment and the opportunity to show best practice, there is evidence that innovation is not being produced by this consolidation while prices are going up, said Samitt. And what happens if systems continue to get larger without pursuing and implementing systematic change? Disrupters like Amazon will continue to get into the healthcare business and do it themselves, he said.

“If we don’t change, someone will change us,” he said. Mitchell agreed, noting that the expectations of consumers exceeds what the healthcare system can currently provide and that the industry needs to move faster to be able to compete with these disrupters.
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