In this first 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.
Q: What are your thoughts on the future value based contracts and contracting? What has your experience with your analytics and the investment you made, taught you about value-based contracts?
Reedy: We do believe that value-based care and contracting is here to stay as we sit across the table from our health plan partners on a regular basis. They're really holding us accountable to value-based outcomes in order to maintain the fee schedules that were paid as well. So it really does become a complete balance in terms of looking at our revenue, and planning to be successful in both. We're very fortunate at Summit, that we've built a clinical model that allows us to be successful in both. We are a multi-specialty group that provides almost every specialty and every type of ancillary service under one tax ID and within one medical group, which is very convenient for patients. Keeping that care in the family at Summit, we've been able to show over the years that coordinated, one-stop shopping type of care actually improves the patient experience, but also appropriately lowers the cost of care. Our health plan partners see that and reward us for that.
I think value-based care is not going to go away. The cost of healthcare continues to go up and it's unaffordable for patients. It's unaffordable for employers, and it's it's not sustainable. The industry is going to continue to find ways of improving outcomes at lower costs. And that's true, not just for our commercial and Medicare Advantage health plans, but it's true at the CMS, Medicare level as well. I think where our analytics helps us again, is we come to the table for those discussions very prepared. We have our own analytics that helps us identify the opportunities for an appropriate "We do, you do" model, which is what we call our relationships with the health plans, "What do you bring to the table?", "What do we bring to the table?," and "How can we share responsibility and accountability for managing patients?." Having a full data set allows us to bring those opportunities to the table and have those discussions which very positively inform our contract negotiations.
Q: There have been calls to start reducing a number of value based programs, particularly those coming out of CMS. So do we think it's time to cut back on the number of value based contracts?
Parikh: CMS created CMMI to experiment and figure out which models will work and test things out, I think it would be nice to go ahead and start, if not reduce the number of miles at least aligning what provides that are held accountable. From our point of view, we have 20 value-based contracts and if you look at them individually, we want to have more value-based contracts with every one of our payers. But what would be great for us is to be able to make sure that our payers hold us accountable to the right population. Is it really the population that we should be responsible for, and then hold us accountable to meaningful measures that actually drive better care at a lower cost and then be appropriately rewarded for that? So I think that fewer models is not necessarily the right term, but I think aligning the way the methodology of these models would really help us reduce the burden of reporting, calculate our stuff and instead focus our efforts on really just continuing to improve care.
Q: Do either of you have any thoughts or insights into the current administration's policies on value-based contracts and the shift from volume to value? Is it even on the radar?
Reedy: Well, the shift from volume to value is on everyone's radar. I think that shift in the focus on improving outcomes and rewarding providers who provide high value care is actually a bipartisan focus. I don't see it as any different under the current Biden administration. I think that Biden and his entire CMS and CMMI team are very focused on affordability. They're focused, as we were just referencing on making sure that the models they support, whether it's an ACO model, or many of their bundled episode models, are actually being deployed in the right places. I think that they're going to very significantly increase their focus on health inequities. There's been a lot of discussion around how we can, as provider groups, do a better job of collecting data related to health inequities, and the social and demographic needs of our patients, and then how we can utilize that to improve the services that we deliver to our patients.
What I'm seeing, at least from the folks I'm talking to in Washington, is just continued commitment on the journey toward value, and a recognition that we've learned a lot over the years that CMS and CMMI have been supporting these models. I think they're just going to continue to refine and make them better and easier for provider groups to participate. I also think the latest, proposed Physician Fee Schedule has some some really good changes in it that are going to help make it easier for us all to participate in, do the right thing for our patients and minimize the costs related to participation in those value models.