The Challenges Of Value-Based Care
Value-based care can deliver results, but it is not easy to achieve.
Optimus Healthcare Partners was formed in 2011 by the Vista Health System Independent Practice Association and the Central Jersey Physician Network, our accountable care organization (ACO) began its value-based care journey in April 2012 when it was selected for the Medicare Shared Savings Program (MSSP).
About a year later, we continued our transition to value-based contracting by signing a commercial agreement with Aetna. This agreement established a new payment model that rewards doctors for meeting quality, efficiency and patient satisfaction measures, including:
- Preventive care and screenings
- Improving the management of chronic conditions
- Reducing avoidable hospital re-admissions
- Reducing emergency department (ED) visits through expanded primary care hours and better care coordination
Aetna also implemented a Medicare Provider Collaboration model with us to support our Medicare Advantage members. Many of these members have complex health care needs. Aetna’s embedded case managers work on site with our doctors to coordinate care for these patients.
But here was the challenge: While some doctors were already familiar with value-based payments through their participation in pay-for-performance contracts, there was a learning curve for most of us. To ease the transition, we worked with physician leadership to build a culture that was open to new models of care delivery. By doing so, we were able to create a common vision for accountable care across the organization.
As a part of these discussions, we made the business case for transparency in practice patterns, quality and efficiency. We also emphasized the importance of performance measurement and data sharing. To that end, we invested in technology solutions to help facilitate these changes. With the addition of a Web-based population health management tool, doctors can now identify those patients most in need of interventions. From there, they can build customized care plans and close gaps in care.
Around the same time, we introduced secure text messaging to streamline communications between providers. We also helped doctors engage with regional health information exchanges. Through these connections, they can access, share and update patient records for treatment received from our providers or those at nearby facilities.
Lastly, we rolled out a performance improvement program to help drive adoption of these tools. The program consists of five different areas where practices must demonstrate competency. If the practices fail to do so, they do not receive their full care coordination fees.
While efforts to expand clinical integration at Optimus were underway previously, MSSP was a catalyst in moving our organization forward and getting individual practices on board. After joining forces with Aetna, we became even more integrated from both a clinical and financial perspective. We also began to see results much faster than we had before.
Using Aetna’s data analytics, we can now drill down and find specific opportunities to improve care. When new opportunities are identified, our providers work together to closely monitor patient progress, engage patients in their care and coordinate treatment.
This team-based approach extends across our network. It includes all of our specialty physicians and hospital partners. For example, population care managers who are clinically trained specialists frequently share best practices across the ACO. This helps promote greater consistency and coordination organization-wide.
By regularly monitoring quality measures, utilization and medical costs, we can gauge our progress toward three-part aim goals. Today, the costs for patient care in the ACO perform better than the market average. They also show a 6.2% improvement since their baseline year.
In addition, Aetna’s Medicare Provider Collaboration program has improved outcomes for these members. By working alongside our doctors, Aetna’s nurse managers help increase adherence to clinical best practices and treatment plans.
For Optimus and Aetna, our accountable care collaboration has produced better outcomes at a better cost. As value-based payment models evolve, our ability to positively impact the quality and affordability of care will only improve. By embracing these models and strengthening care coordination, we can stay focused on patients and improve the total care experience.
John F. Vigorita, MD, is the Chief Executive Officer of Optimus Healthcare Partners, LLC.
