The Intersection of Healthcare Delivery and Healthcare Financing

In this two-part blog series, we’re taking a look in the rear-view mirror at our ninth annual ReviveHealth Summit, which took place last week in Laguna Beach. Our first blog explored the underlying current of health technology throughout the keynote presentations. Today, we’ll uncover insights and trends arising from our four panels

Given the event’s strong focus on managed care, our first panel – the Health System Executive Roundtable – got to the heart of four providers’ experiences and challenges with payer relations and partnerships. While their experiences could make for a drama series on TNT, they also captured four key takeaways to what makes for successful provider-payer collaboration.

  1. Trust and collaboration. All four speakers decried a lack of transparency as their biggest challenge when working with health plans. They are always looking for new approaches to value-based care and fair quality metrics, and asked that payers come to the table with an open, transparent approach.
  2. Access to data. Stuart Kilpinen of Trinity Health probably said it best: “I want information. I want claims data. I want it raw. I want to roll up my sleeves and get into it.” Without a complete picture of patients – which includes claims as well as their own clinical data – true collaboration is impossible.
  3. Value-based care. David Stratton at Catholic Health Initiatives shared how and why his organization embraces value-based care as central to quality improvement and business success. From clinically-integrated networks (CINs) and accountable care organizations (ACOs) to provider-sponsored health plan (PSHPs), realistic risk-sharing is a crucial strategy.
  4. Physician alignment. Building physician loyalty and participation was a theme of the panel, and even the entire event. All speakers emphasized the importance of actively involving physicians and helping them understand their own data, often through novel approaches to peer leadership and risk arrangements

Coming off the heels of this spirited debate was a conversation on ACOs, CINs, and other efforts to coordinate care. Doug Hervey of Leavitt Partners initiated the panel by drilling down on the MSSP program and revealing data on the types of organizations most likely to earn shared savings, such as physician groups, organizations who have prior experience in risk contracts, and providers in high-cost markets.

From there, Dianne Grussendorf from Baylor Scott & White Health and Sean Carroll from Arcadia Healthcare Solutions shared their experiences with risk-sharing and coordinating care. According to Dianne, partnerships (especially joint ventures) are an important strategy, and behavioral health is becoming increasingly important to successful care coordination. For Sean, the key to successful ACOs is mapping out strong governance and leadership structures, while establishing clear communications and flow of data between all parties.

With the challenges and opportunities clearly mapped, our final panels explored novel solutions to the problems at hand. I was privileged to lead these two panel discussions on specialty care and technology solutions for risk-sharing with some of our very own health IT clients.

We opened with a look at how to reengineer specialty care for financial and quality impact, featuring Dr. Robert Hitchcock of T-System, Jim Reilly of MedAssets (now Vizient), and Scott Seidelmann of Candescent Health. As an industry, we’ve spent a lot of time thinking about the role of primary care in population health; but as Nate Kaufman shared in his keynote, those who deemphasize the importance of specialists will fail to impact cost and quality. That’s exactly the opportunity that this panel revealed.

During the discussion, Dr. Hitchcock discussed his own experiences as an emergency physician in repositioning the emergency department as a critical lever to quality initiatives and patient access; Jim Reilly addressed the importance of cross-specialty physician alignment in new payment models; and Scott Seidelmann underscored the shocking variability in today’s radiology industry and how a change to workflow and clinical process can quickly close quality gaps.

Across the board, it was clear that providers should be taking a hard look at their service lines and specialists to uncover new paths to revenue and quality improvements.

The final panel of the day brought the event full circle, looking at new services, technologies, and workflows designed to address the issues identified in the previous 48 hours. Our speakers included Ralph Derrickson of Carena (now American Well); Michael McMillian of Valence Health (now Evolvent Health); and Sanjay Pathak of Kyruus.

We started with the premise that we’ve been trying to figure out bundled payments and risk-sharing since the 1990s, but what makes today different from then is the rise of consumerism and the increased availability of data. And while value-based care is a clear B2B issue, the discussion kept coming back to the role of the patient-consumer.

In this final conversation, Ralph Derrickson shared Carena’s experiences building white-labeled virtual care clinics for health systems to help them access new patients and manage populations; Michael McMillian challenged the room to realize the importance of both performance and actuarial risk in establishing market dominance and relevance; and Sanjay Pathak underscored the role of patient access, and matching each patient with the right provider, to impact quality scores and referral processes.

In short, if you build care processes around patients based on what they need in that moment, everything else falls into place.

With that, perhaps it’s more accurate to say that patients were at the heart of this year’s ReviveHealth Summit. Yet without data and technological infrastructures, it’s impossible to provide them with truly personalized and appropriate care. The good news? We’re finally starting to figure it out.

We hope you’ll join us next year!

November 18, 2015
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