In healthcare organizations’ ongoing march toward value-based care, one of the core challenges in this “new healthcare” is that cost pressures have significantly increased. As such, the burden falls on patient care organization executives to innovate and work towards further enhancing the quality of care, while keeping costs in check.
This is precisely what Centra Health, based in Lynchburg, Va., providing care with four hospitals and 64 locations in all, has set out to do. Two of the health system’s executive leaders— Matthew A. Johnson, vice president of medical affairs, and Karel Bemis, director of accountable care, recently spoke with Healthcare Informatics about Centra Health’s value-based care journey and how IT is playing a key role. Below are excerpts of that discussion.
Where do things stand right now regarding Centra Health’s value-based care progression? At a high level, how fast is the train moving?
Johnson: We are located in Central Virginia, and we have about 8,200 employees with a 2018 projected revenue of $1.3 billion. We have both legacy and best-of-breed data systems, and we are expecting to go live with Cerner on September 1st. Some of the at-risk programs that we have been involved with for a while now are both on the private and public payer side.
Starting with the private side, Anthem has a Quality Insights Incentive Program, and we have been on the hook for this for about six or seven years. It’s a robust program that looks at a lot of metrics such as readmissions, to hospital-acquired conditions, to infection rates, to patient experience. It’s a large program that we pay lot of attention to because Anthem is our largest payer. That’s what got us started.
In 2013, Centra decided to go into the payer business and purchase a [local] health plan located in our region, Piedmont Community Health Plan. In the plan, we are at risk for Medicare Advantage [beneficiaries], the [insurance] exchange population, and then we have our own employees and independents. It was in 2013 when we started to step on the gas and realized it was important to not just take in the premium dollar, but drive value in a population, and understand what’s going on, how patients are accessing care, and what data can we collect on them to manage physician performance. This was the catalyst for a lot of our work.
As far as the government programs at Centra, in 2017, about $10.2 million of the revenue we took in from CMS [the Centers for Medicare & Medicaid Services] for the services we provided was at risk. That money is broken down between the hospital-acquired conditions program, which is a penalty-only program at 1 percent [reimbursement penalty], the value-based purchasing [program], which is a two-sided risk model, at 2 percent, and then the readmissions [reduction program], a penalty-only program, at 3 percent. So those programs got our attention as well.
All of this is just on the acute care side, and when we started to learn about MACRA [the Medicare Access and CHIP Reauthorization Act], we realized that we had a risk corridor of almost $2 million either way, depending on how well we performed under MACRA. So long story short, this was one of the reasons we became a Track 1 ACO [accountable care organization]. We are not on the bleeding edge of change or the lagging edge; I think we are somewhere on the front end of that change continuum. And I would say we are moving along at a moderate pace.
Drilling down, what are the greatest challenges? What needs to happen for more progress in this area? Where do the biggest gaps lie?
Bemis: Our greatest challenge is becoming a high-value provider network in the area. To do that we need to put our network at risk, combine that with business intelligence, look at dashboards, information coming out of EHRs (electronic health records), and take all that and roll it with physician change management. We need to work with physicians, educate, and figure out their workflows while hearing their needs. Once we understand their needs, we can put that with the data and work with our health plan, which will give our provider network super insight, almost making them subject matter experts so they can do the best job out there for population health. The biggest challenge is getting physician change management to work, and taking those slow steps by walking a mile in their footsteps.
What type of innovative technologies are on the horizon, or are already being deployed at Centra, that can help your organization on this journey?
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