How are large employers adapting to, and benefiting from, the value-based care practices that are a payer demand and a provider imperative? This was the focus of a panel moderated by Bo Gamble, director of Strategic Practice Initiatives, Community Oncology Alliance (COA), during the 2018 Community Oncology Conference hosted by COA, April 12-13 in National Harbor, Maryland.
How are large employers adapting to, and benefiting from, the value-based care practices that are a payer demand and a provider imperative? This was the focus of a discussion at a session moderated by Bo Gamble, director of Strategic Practice Initiatives, Community Oncology Alliance (COA), during the 2018 Community Oncology Conference hosted by COA, April 12-13 in National Harbor, Maryland.
Gamble was joined by Robert LoNigro, MD, MS, executive vice president, Health Care Operations, Heritage Provider Network, HealthCare Partners; Sarah D. Ponder, director, Client Success, Semma Health, Inc; John Robinson, president, chief executive officer, RobinsonBush; and Jeffrey Vacirca, MD, FACP, chief executive officer, NY Cancer & Blood Specialists, and president, COA.
The discussion started with each panelist sharing their experiences on value transitions and quality reporting.
“Value is tough to define,” LoNigro said. “It’s not easy … it takes transparency and knowledge sharing on what we have in common that is easy to achieve.”
Ponder’s organization has identified one crucial disconnect: benefit directors do not have true data visibility. So, their strategy is to “leverage medical claims from both employers and providers to identify opportunities for cost saving.”
Along those lines, Ponder’s team chooses independent physicians or practices as local partners to provide high-quality and low-cost care. “We also have an alert system for new members that join our provider partners,” which, Ponder said, can assist employers when they try to budget insurance spending for their employees. “Predictive analytics have also helped out for high-cost claimants.”
“What are you doing to identify your market and your customers?” Gamble asked.
“Our first employer partner was a manufacturing company that has a $4 million annual oncology spend,” Ponder said. “We have provided them with a better understanding of the difference in spending trends between an independent provider and a hospital-based provider, so they know where they should be spending their dollars.”
Robinson’s company, RobinsonBush, collects claims data from its clients to evaluate the cancer costs that they encounter for their employees. “We were working with the Florida Healthcare Coalition and observed the growing costs [of cancer care among their employees].” One of the things that Robinson decided to do was to speak with some of the cancer survivors and their managers.
“I went with the idea of asking a few questions, but I was there for more than 2 hours listening to the experiences … hearing about patients’ agonies pre-, during, and posttreatment,” Robinson said. These interactions gave him and his organization a much better understanding of the communication and clinical gaps that patients experience.
“Working off of these interactions, we made decisions to fill those gaps,” he said, and they are using this information to develop cancer programs for their clients.
Lessons Learned and Changes Implemented
Gamble then asked the panelists how they were changing quality and value concepts and the movement they are witnessing.
“We have been having conversations around this,” Vacirca said. “It’s gratifying to work with payers who are aligned with us on this.” He mentioned that his practice is working on efforts such as ensuring low hospitalization rates, for which they have set up a triage system at their practice, so patients have access to a nurse, at least on the phone.
Vacirca also explained that their largest practice keeps its doors open on the weekends, which ensures patients do not end up in the emergency department. “It’s important to keep the payer informed on these changes at your practice.”
And who is the most appropriate person to speak to the patient about treatment costs?
“Studies have shown that providers are the best positioned for this discussion,” Ponder said, but often lack details on things such as out-of-pocket costs that a patient may encounter. She said that her organization is empowering physicians and practices with this knowledge so they can bring it to the patient.
“Emotional and challenging stakeholder issues are a part of this conversation,” LoNigro said. “When a patient is diagnosed, the world shifts—and the first interaction that happens after this shift is with the provider. That’s the starting point.” He emphasized that the way the cost-sharing information is presented to the patient is important, because it changes the trajectory of their thought process.
This information should also be brought to the employer as critical value advice.
Robinson’s company is in the process of developing an employer client—specific program and he mentioned that Florida Cancer Specialists are one of their clients. “We are addressing some barriers, such as patient confidence in their diagnosis and treatment,” he said. However, a clinical quarterback is vital for the success of such programs as well, Robinson added.
Vacirca said that as a group, we need to take an inventory of all the practices around quality and value that that clinics have implemented and bring this information back to the payer partners. At his practice, NY Cancer & Blood Specialists, they have given hospitalists that their patients visit access to the patients’ records in their electronic health record. “This ensures that our patient’s information is in front of them; it also reduces unnecessary duplicate testing and allows better treatment decisions. We should let payers know about this,” Vacirca said.
Healthcare should be personal and local, according to Robinson, and patient experience is an important part of this conversation. “Its about brining the whole community together and aligning them on their ideas and functioning.”