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At the World Health Care Congress, a Probing Discussion of the Shift Towards Value

April 30, 2018
by Mark Hagland
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Industry leaders parse some of the complexities around the shift towards a value-based healthcare system

What is the path into value-based care in U.S. healthcare going to look like in the near future? Somewhat rocky, that’s for certain. That certainly was the consensus among industry leaders participating in the opening panel Monday morning at the 15th Annual World Health Care Congress, being held this week at the Marriott Wardman Park Hotel in Washington, D.C.

With the title, “Make Value-Based Care a Reality,” panel participants, drawn from across the sectors of U.S. healthcare, engaged in a very lively discussion about the challenges, opportunities, and complexities of the shift taking place in the U.S. healthcare system from a payment system that remains fee-for-service-based for the most part, to an emerging system that will be incenting value to all stakeholders in the system.

The panel was moderated by Ceci Connolly, president and CEO of the Washington, D.C.-based Alliance of Community Health Plans, a national association of 49 community health plans. Connolly was joined by Phil Jackson, CEO, health plan products, at the Sacramento-based Sutter Health, an integrated health system with 24 hospitals across Northern California; Paul Kusserow, president and CEO of the Washington, D.C.-based Amedisys Inc., a nationwide home healthcare provider; Karen Spring, president, healthcare operations, at the St. Louis-based Ascension Healthcare, the nation’s largest Catholic-affiliated integrated health system, with 153 hospitals; and Matt Wallaert, chief behavioral officer at Clover Health, a San Francisco-based health plan that describes itself on its website as “a software driven health insurance company leveraging data analytics and technology to partner with providers to fill gaps in care and help drive clinical operations workflow.”

In introducing herself at the beginning of the discussion, Ascension’s Spring said,  “We’re the nation’s largest not-for-profit health system, and we’re actually the world’s largest Catholic healthcare organization. We’ve been structured around people being sick. And we know we need to move towards prevention and wellness. The tertiary care hospitals will all be there. But we need to be in our communities. We have 153 hospitals, and senior living. What we need to be focused on is how we keep people from needing our hospitals, how we help them to feel better about life.”

Further, Spring said, “In Nashville, for example, we have high smoking rates, obesity, diabetes, which means we need to do better. We want to make communities healthier. And we took a bold move this year, for example… last year, we were able to reduce CHF readmissions across all our entities; this year, we’ve focused on not even to admit CHF patients to begin with. We’re about 50 percent at risk—combination of full risk, shared risk, and MSSP ACOs [Medicare Shared Savings Program accountable care organizations]. We haven’t moved as fast as we’d hoped we would. But reimbursement remains a challenge,” added Spring, who noted that she began in healthcare as a practicing nurse in the mid-1980s, and has been with Ascension Health for seven years.

“We are now the largest independent home health, hospice, and personal care company in the country,” said Kusserow, who noted that Amedisys Home Health employs 18,000 healthcare professionals working in 35 states. “Our major competitor is being acquired by a payer. So in people’s attempts to move towards value-based purchasing and delivery, we’re starting to see a lot of influence in terms of the payers and providers getting together, to deliver strong value. Today,” he noted, “we will be in 45,000 homes calling on people. Our job is really simple: to allow people to live independently in their homes. And the Baby Boomers don’t want to be in institutions. And we’re moving very quickly from an acute-based system to a chronic care-based system.”

One key element in that, Kusserow noted, is the aging of the population, and the growing percentage of seniors in the U.S. “People are expecting to live 20 years beyond the age of 65, and at 65, you first start to typically exhibit a chronic illness. Most of our business is FFS. I come from a payer background, also ran hospitals for seven years as well. So I’ve been in a lot of places in the HC system. I think the paradigm is shifting. Payers are acquiring providers, and are going to achieve value that way. And the key paradigm shift will be to keep people out of institutions.”

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