A Soft Landing For Value-Based Care
Making the move to value-based care is a big step. It means shifting from the old “one-patient-at-a-time” mentality to a new mindset focused on entire populations. It means going beyond encounter-based medicine to a more coordinated approach that unites providers across the continuum of care. And, it means making significant investments of both time and effort related to culture change and clinical integration.
In the second year of Optimus Health's value-based agreement with Aetna, we achieved impressive results for our commercial members. We also performed better than the baseline year in the following areas:
- 38% improvement in 30-day readmissions
- 30% increase in generic prescribing
- 24% decrease in impactable surgical bed days per 1,000
- 17% decrease in medical bed days per 1,000
Our costs have improved as well. Since our baseline year, we reduced medical costs by an additional 6.3%, which means we now perform 89% better than the industry average. These results validate our philosophy that providing high-quality, high-touch care is the path to cost stabilization and cost reduction.
Although we’ve made significant progress in improving the quality and cost of care, we believe we can make an even bigger impact. For example, while we’ve created an environment focused on improving quality, reducing costs and enhancing the patient experience, we feel there is always room to grow.
Many of our primary care physicians (PCP) understand the importance of value-based care, but now it’s time to find new ways to keep engaging them. It is also time to expand our efforts to include specialists as well. To that end, we will continue to:
- Share best practices
- Use performance metrics
- Offer access to the right tools. With Aetna’s web-based population health management tool, our physicians are able to identify high-risk patients. They can engage with those individuals who need more support, build customized care plans, close gaps in care and improve outcomes.
Data transparency has been another key to our success. As our collaboration with Aetna matures, we’ve benefitted from improved data flow and communication that allows us to better understand the factors and trends that impact our clinical and financial performance. For example, Aetna provides prescribing data that allows us to identify opportunities for reducing costs. With greater visibility into the prescribing patterns of our physicians, we have been able to improve our generic prescribing rate by 13% for all drug classes since our baseline year.
Having a steady flow of population health data, prescription information and clinical notifications related to hospital admissions and discharges also gives our physicians actionable insights they can use to close gaps in care, follow up after a health event and make smoother care transitions. In the future, we plan to drill even deeper into the analytics and dashboards we receive from Aetna to drive additional improvements in quality and care delivery. These insights play a key role in supporting our collaborative care strategies by enabling us to Better manage high-risk, high-cost patients, encourage more appropriate utilization, improve care transitons and patient outreach.
As we move forward in our journey, we intend to continue our focus on team-based care by developing closer collaborations with hospitals, skilled nursing facilities and other payer groups. The more we can effectively coordinate care and manage care transitions, the more we’ll be able to improve care and outcomes for our patients. We also plan to conduct a patient experience survey across the entire organization to help identify ways we can enhance satisfaction and build loyalty.
John F. Vigorita, M.D., is Chief Executive Officer of Optimus Healthcare Partners, LLC.
