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LIVE FROM HIMSS16: Are We At an Inflection Point into True Provider-Payer Convergence?

March 1, 2016
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Two presentations at the Business of Healthcare Symposium at HIMSS16 spoke to a realignment of interests
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The closing keynote presentation in the Business of Healthcare Symposium on Monday at HIMSS16 really helped crystallize so much about this moment in healthcare. Even the professional title of the presenter spoke to it. The presenter was Veeneta Lakhani of the Indianapolis-based Anthem, which insures 38 million covered lives across the U.S., and which has contracts with 796 hospitals and 54,000 providers, and has over 4.5 million members in more than 154 ACO contracts nationwide.

Ms. Lakhani’s title? Vice president, provider enablement.

Indeed, everything about Veeneta Lakhani’s presentation on Monday after spoke to the current moment in U.S. healthcare And, following immediately after the excellent presentation, “The ROI of ACO,” by Douglas J. Van Daele, M.D., vice dean for clinical affairs at the University of Iowa Health Care, Lakhani’s presentation spoke to the massive shift in perceptions and interactions that has taken place among providers and payers in the past decade.

Ten years ago, it would have been virtually unthinkable to have a provider leader (not to mention a physician executive at an academic health system) and a health plan senior executive, follow one another on a symposium program, and say essentially the same kinds of things—from the provider and payer perspectives of course—about payment incentives and collaboration. And yet these were exactly the kinds of presentations that took place at the Business of Healthcare Symposium on Monday. Indeed, the subtitle of the symposium, or its tagline, was this: New Payment Models: Are You Ready?”

What’s more, both Ms. Lakhani and Dr. Van Daele both spoke extensively and clearly about the criticality of strategic information technology, and of the participation of healthcare IT leaders, in the needed transformation of the U.S. healthcare system that both presenters agreed was and is needed.

As Lakhani said to her audience, speaking of health insurers, “We need to play a role in transformation. That started with the incentive system. Our framework for thinking about it is that there’s are three kind so relationships we seek,” she said. “One is a payment innovation relationship—value-based payment. The other is partnerships—product partnerships; Vivity is a good example in California. We’ve essentially partnered with seven systems in CA and launched. The third is payment reform.”

Veeneta Lakhani at the Business of Healthcare Symposium

Essentially, Lakhani said, she and her colleagues at the massive Anthem are seeking to create repeatable payment and partnership models we can scale across the country.” And that statement reflects what are apparently the sentiments of senior executives at all the largest for-profit health insurers nationwide, as well as those of executives of the Blue Cross and Blue Shield plans and other not-for-profit health plans across the U.S.

As Lakhani noted, “We committed to this”—to partnering affirmatively and collaboratively with providers—“in 2012. About 37 percent of our medical spend is under a value-based payment arrangement today, and we’re moving to a strong commitment to 50 percent by 2018. We’re in this, we’re committed,” she repeated, adding that “We see payment innovation as a part of a spectrum.” That spectrum, she said, includes a vast range of possibilities, including “global capitation, shared savings/risk, bundled payment, P4P, tiered benefits, reference-based benefits, transparency. We ultimately do want to get to global capitation,” she emphasized.

Not only are the senior executives at the major private health plans committed to partnering collaboratively with providers to improving clinical outcomes and bending the cost curve—and in that, their interest in transforming U.S. healthcare through collaborative models mirrors that of the federal officials overseeing the Medicare and Medicaid programs—they recognize that healthcare IT strategy—and people—will be crucial to the success of any such ventures.

IT and data will be essential for establishing and measuring outcomes (there are currently 34 measures in Anthem’s quality scorecard, for example—the use of portals for plan members parallels very closely the development of portals for patients on the part of patient care organizations); IT and data will be vital to the marrying of clinical and claims data and its analysis on the part of collaborative health plans and providers; and it will be vital to the engagement of physicians in clinical performance efforts.

Indeed, as Lakhani noted, she and her colleagues have been measuring and continue to measure, progress with providers in moving forward to cut costs and improve clinical and health outcomes. For example, she noted, “We established a risk-based control measure,” in moving forward with provider organizations on risk contracts, “and matched members in our cohorts to a control group.” The results? The ACO model-based providers achieved a $9.51 per member per month in reduction against the control group.”

What’s more, Lakhani said, “We have some really great positive signs of success in our cohorts. The performance [among providers] is not equal; we do see variance. We’re very committed to making sure we really understand what drives the best, and what capabilities we need to bring to bear.”