Value-based payment is coming to health care. And its complications are something we have to understand.
That was the message of panelists Wednesday during a session at the H&HN Executive Forum in Chicago on value-based payment and purchasing and what can make it successful.
"At the end of the day, it's really the total cost of care for the population you're responsible for," said Stephen Rosenthal, senior vice president of population health management of Montefiore Health System in New York City, and president and chief operating officer of CMO, Montefiore Care Management Co.
For Jay Bhatt, D.O., the American Hospital Association’s chief medical officer and CEO of its Health Research & Educational Trust, new payment models are a new solution to an old problem: delivering health.
"Value-based care is about systems that reward desired outcomes," he said.
Payment models focusing on value, not fee for service and not just quality, are being rolled out by the Centers for Medicare & Medicaid Services and are being adopted by private payers and health systems alike.
Louis Shapiro, president and CEO of the Hospital for Special Surgery in New York City, said that, on its face, value-based care seems obvious. "How could you argue with the concept?" he said.
"The real challenge is not how we get paid but how we deliver value," said Shapiro, who added that payment follows that.
Rhonda Anderson, a consultant with RMA Consulting of Arizona and former CEO of Banner Health’s Cardon Children’s Medical Center in Mesa, Ariz., said that a discussion of value-based purchasing needs to be framed by a discussion of how health care is changing overall. Among other elements, this involves a transition from an "illness system" to a "health system" and from a fragmented to a coordinated one, and a move to a system where patients are more and more engaged, she said.
Much of the discussion, led by moderator Robert Nesse, M.D., senior medical adviser for payment reform to the Mayo Clinic Board of Governors and former Mayo Clinic Health System CEO, focused on leveraging data to track value.
According to Bhatt, analytics plays a crucial role. "Hospitals and stakeholders have to understand the problems they're trying to solve," he said.
"One place we need to get to is to share the kind of data we need to drive effective decision-making," said Steven P. Johnson, president and CEO of Susquehanna Health in Williamsport, Pa.
Different panelists, led by Nesse, stressed that the challenge is to apply data to different conditions and patients even when population health numbers are available. Some mentioned that the inaccessibility of data held by insurance companies can be frustrating.
Nesse asked the panelists whether we need a national conversation on the rules of the game for measuring and paying for value, not just agreements between providers and insurers. "Is it a team sport?" he said.
Panelists also responded to an audience member's question about whether value-based payment could lead to unintended consequences when treating patients requiring ongoing, intensive treatment. Rosenthal said there are protections and even incentives in place to provide treatment in such circumstances, while Johnson pointed to what he said was another conundrum: "How do we finance wellness care?"
Hospital leaders have to pay attention to explaining value- and risk-based payment programs to trustees and encouraging buy-in by physicians, panelists said.
"We have to do the framing for them so they realize this isn't business as usual," Anderson said.
According to Rosenthal, "We spend a lot of time explaining what it actually means to be financially at risk."
But engagement can be seen as just part of the daily routine.
"Part of our job is motivating people to do what we come to work for: making people well," Nesse said.