Hospitals and health systems continue the balancing act of operating in fee-for-service and value-based payment environments. As they shift the focus towards population health management, they must be responsive to the community’s needs, while often navigating conflicting regulatory pressures. Value-based care measures remain primarily hospital-focused, in conflict with efforts to enhance population health and achieving the Triple Aim, according to panelists in an executive dialogue held May 2 in Washington, D.C., at the AHA’s Annual Membership Meeting, with sponsorship by Siemens. “Ideally, measures would be focused on the needs of the community and the community health assessment,” says Wright Lassiter, president of Henry Ford Health System, Detroit. “We’d like to focus on what’s going on outside the walls of the hospital. This would include longitudinal and wellness metrics, and chronic disease stats. That’s where we have the greatest opportunity for improvement.”

Physician integration continues to remain a challenge — particularly obtaining buy-in from community-based physicians, although progress is being made. “Their payment model is different,” notes Lassiter, of the organization’s community-based physicians. “It’s not an issue of convincing them that what we’re trying to achieve is right thing to do. It’s helping them understand how it fits in their world.” At Advocate Health Care, in Downers Grove, Ill., shared governance and physician involvement in the standard setting process has shown to be a successful model. “Through shared governance, we’ve created an environment that’s competitive and engaged,” says Meghan Woltman, Advocate’s vice president of government and community relations. “If physicians aren’t willing to practice by the standards in place, they are encouraged to go elsewhere.” Advocate is far along in its transition to value-based care, with the majority of its revenue coming from risk-based contracts. “We’re at a critical mass that changes culture,” Woltman says. “It’s completely changed how we view our traditional revenue centers.”

At Susquehanna Health, in north central Pennsylvania, establishing solid partnerships with physicians and suppliers is helping to enhance efficiencies and the overall patient experience. “What we’re looking for is greater appreciation from our community physicians, as well as from out business partners, to help us identify and meet the data points that are most meaningful and to put them at risk along with us in our contracts,” says Steven Johnson, Susquehanna’s president and CEO. “We’re just a couple years into this, but it’s been helpful.”

Although as a critical access hospital, HSHS St. Francis in Litchfield, Ill., is not currently subject to value-based reimbursement, demonstrating value to the community is imperative, says president and CEO Patti Fischer. “We strive to be transparent and have adopted core clinical measures, even though we aren’t subject to value-based reimbursement,” she says.  “We’re always thinking forward, what’s next.” Adds Michael Ungvary, Siemens’ vice president of corporate strategic accounts, “It’s an interesting time for hospitals and health systems. One of the ways to manage cost, and deliver value, is to eliminate variability. It’s more than just the right thing to do.”

This dialogue is the first in a three-part series that will be published in H&HN Daily. The next installment will be featured in August.