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In this final part of a two-part video series, Briana Contreras, associate editor of Managed Healthcare Executive, spoke with Summit Health’s Chief Quality Officer Ashish D. Parikh, MD, and Chief of Population Health Jamie Reedy, MD, about value-based care programs and contracts within Summit Health and what it takes to invest and implement these programs into your healthcare organization.
Below is a brief Q&A of the interview with Reedy and Parikh that has been edited for clarity.
MHE: Can either of you provide some details on the seven valued-based contracts? Are these ACO contracts? Bundled payments? Are you a Medicare Shared Savings Program ACO and have you taken on two-sided risk and, if so, for how long? Lastly, what percentage of your revenues would you say come in through value-based contracts in contrast to fee-for-service?
Reedy: In our New Jersey market, we are actually participating in managing 10 value-based contracts and in our Oregon market we have another 10. So there is much experience and that's across all lines of business, Medicare, traditional Medicare Advantage, commercial and Medicaid in our Oregon market. We are participating currently in our sixth and final year of the "Next Generation," a co-program with CMS, and we will transition January 1, 2022 into the Medicare Shared Savings ACO. At this point in time, I'd say probably about 5% of our revenue is related to value-based care revenues. But it's rapidly growing. We actually got into commercial risk 10 years ago, long before we even jumped into a Medicare ACO. Every year for the last decade, the percent of our revenue has been increasing.
To address your question about two-sided risk: the Next Generation ACO model has always been a two-sided risk. We've always had substantial downside risk as part of that model. We've also had downside risk in two of our commercial ACO contracts for many, many, many years. So we're very familiar with managing against that risk.
Parikh: We've used our long track record of high value, high quality care with our payers to negotiate a fee-for-service rate. I'd say a significant chunk of our fee-for-service revenue actually can be attributed to value-based care.
Contreras: You decided to increase your investment in analytics as a way of managing your value-based contracts. Could you provide some detail on the problems were you responding to? Were you losing out on shared savings? Were you not meeting quality metrics? Was it an attribution problem?
Reedy: So we were relying solely on the data and reports that came to us from our health plans, which they of course, were using claims data to analyze our performance across attribution, quality, utilization cost. And then in our electronic medical record, we had clinical data, but we didn't have the ability to pull the data together, we had no tool or platform or vendor to combine those two data sets: clinical and claims data, along with many other data sources externally like ADT data, and so forth, to allow us to be more sophisticated about tracking and monitoring the success that we had across all of those metrics, quality measures, utilization and cost.
We knew that in order for us to get to the next level, in value, and be able to truly have prospective knowledge of where our opportunities were to lower cost, we had to find the right solution, the analytic solution, for us to be able to combine those datasets. We began a journey a number of years ago, talking to vendors in this space, and really trying to find a partner that truly understood value-based care and value based contracting, and the features that we would need as part of an analytics platform to allow us to build on the success we had already had.
Contreras: Could you provide some of your analytics investment, maybe the size of the investment and over how many years? And I guess in more simple terms, what sort of analytics? Do you work with a particular vendor or vendors?
Reedy: We signed a contract with Arcadia a couple of years ago and did invest in a five-year agreement with Arcadia. We really wanted to invest together in our shared success. We have had a phenomenal relationship for a number of years as we've integrated a lot of data sets into the platform. We also were created in the beginning when we negotiated the contracts we included a monthly bucket of ours for utilizing Arcadia's very sophisticated and skilled analytics and insights Team. We knew from the beginning that we couldn't just make an investment in a platform or software, but we needed to make investment in people as well. We needed to accelerate our ability to use the platform and use the data.
So while we are making investments at Summit in building a very skilled and large value-based care analytics team, we also knew that that would take time. We partnered with Arcadia to utilize their experts who could both train our team, but also accelerate our learning of how to use the platform and how to identify those opportunities for us to build clinical programs and lower the cost of care.
Contreras: Could either of you discuss the results of this investment?
Parikh: In our 10 year journey we've luckily always been successful in our value-based contracts and then have been able to enjoy shared savings and high quality benchmarks. But as you know, year over year, the benchmarks keep getting higher and higher. The market keeps moving ahead so you have to continue to improve constantly. What our daily data analytics platform has done for us is allow us to really hone in and take the strategies that are working and reinvest them in further, find things that maybe aren't working as well and tweak them, and then help us align our incentives.
For example, with annual wellness visits, we wanted to see, "Is there a real impact on the population?" What we found was that our population that got annual wellness visits, had significantly better quality gap closure and better outcomes, as long as they continue to stay attributed to us. Because of that, they had better adherence and stickiness to the group.
Another example would be how we used our data analytics to improve the incentives that we're giving our providers. For example, now, we are able to take each primary care providers panel and figure out what their risk adjusted admissions is per 1,000, as well as their impact on our overall quality performance as a group. Based on those two things, we're able to incentivize the pros and give them actionable data to continually improve themselves. So certainly, we've been able to use our data on investment to help us figure out how to continue to be successful.