What does the journey into value-based healthcare delivery and payment look like, at the patient care organization level? On Wednesday, two senior executives from the MetroHealth System, an integrated health system in Cleveland, shared some insights into their organization’s journey so far, at the Health IT Summit in Cleveland, sponsored by Healthcare Informatics.
In their keynote presentation, entitled “MetroHealth’s Road to Success: The IT Approach for One of 30 National Successful MSSPs,” Nabil Chehade, M.D., senior vice president of population health, and David Kaelber, M.D., Ph.D., CMIO and vice president of health informatics at the 731-bed system, which is anchored by MetroHealth Medical Center, shared with their audience both the high-level strategic components of their accountable care work, and the strategic and practical IT elements involved. MetroHealth was an early participant in the Medicare Shared Shavings Program (MSSP) for accountable care organizations (ACOs), and its leaders already have a host of learnings to share with colleagues across U.S. healthcare, regarding the challenges and opportunities in this area.
Starting at a U.S. healthcare system-wide level, Dr. Chehade began the joint presentation by contexting MetroHealth’s work in this area. Speaking of the overall U.S. healthcare system, Chehade noted that “We spend 17-18 percent in this country, compared to an average of 10 percent” among other advanced industrialized nations. “Do we get more out of spending more? Actually, we don’t. And there is county-level data that shows you how every county in this country is doing” in terms of clinical and health outcomes. “I can tell you that Ohio doesn’t do very well. More importantly, with regard to this county, Cuyahoga County, which is home to some of the best patient care organizations, on a national level, still, this county’s health outcomes are some of the worst.”
In fact, Chehade said, “What we have built throughout the years is a system that doesn’t work. How can we spend all this money, without a lot to show for it? If you were running a small business yourself, you would never run it that way? But somehow, we allow it to happen in our system.” Thus, the burning platform for population health. “What is population health? Do the right thing for the patient, give them better care, good service; but at the same time, there is only a limited amount of dollars, so how can you use those dollars to deliver the best kind of care? Population health medicine is a different way to deliver care,” he said.
And, Chehade noted, the Affordable Care Act, passed in 2010, helped to push providers forward towards value-based healthcare, with its numerous provisions for accountable care and bundled payments. In that, he and his colleagues at MetroHealth have been eager to move forward with alacrity into value-based care. That said, he noted that “It’s a fine balance for any organization to live in both worlds, the fee-for-service world and the value-based world. Is there a way to do it? Of course there is. Where there’s a will, there’s a way.”
Further, Chehade said, “Why do we believe we can do this? The first pillar” in his organization’s efforts has necessarily been “our patients and our providers. We still serve a lot of less-fortunate population. Close to 40 percent of our patients are Medicaid patients. And just because we had so many Medicaid—and uninsured, before Medicaid expansion in Ohio—patients, we had to work hard to successfully serve those populations. But that has led us to be able to recruit clinicians and others who share that sense of mission.” Meanwhile, he noted, “The march from fee-for-service to value-based will never happen if an organization’s leadership is not fully committed. Our leadership committed to branding MetroHealth’s transformation as a transformation to population health. That’s what we preach and live every day, and that’s very important.”
In that, he said, “We started by building up our patient-centered medical home. Then came the pre-expansion waiver under Medicaid. MetroHealth was a demonstration site, and we did very well. Then, in 2014, we entered MSSP Track 1. In 2015, we entered with our largest HMO payer for Medicaid, with 70,000 lives. And then in 2016, when I arrived at Metro, we established the Population Health Institute. And soon we decided to take not only upside risk, but upside-downside.” For example, he noted, “In the Medicaid CPC Ohio program, we’ve taken both upside and downside risk for 100,000 lives.”
As a result of those initiatives, Chehade said, “Looking at our core population, 75 percent of patients are in a value-based contract; and in Medicaid, it’s nearly all patients in some kind of risk contract. How do we do this? We start with payment reform. We believe we’re the only organization in the country where any contracting in value-based payment is first run through our department [population health], and not the CFO; and we believe that’s very important, because it aligns the flow of money. Then we start segmenting the population, creating patient registries. We look at our community of patients and how we’ll engage them. And how can we transform ourselves. And in every single step of the process, we need to engage our IT and informatics.”
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