7 Takeaways from the ‘Value-Based Care Models’ Conversation at Synergy Summit

Together, they may be the few leaders nationwide “running risk-bearing organizations born out of post-acute provider organizations and led by post-acute-provider-background CEOs,” Fuller told the audience. As “unicorns” in the industry, these two thought leaders have a unique perspective. During their “Fireside Chat,” they addressed the long-term care operators in the room, but also have a message for Accountable Care Organizations (ACOs), Direct Contracting Entities (DCEs), hospitals, and payers on ways to manage total cost and quality of care. However, both speakers stressed that these entities must understand that they need the post-acute care community to do it effectively. Transitioning to “value-based care has been very difficult for our industry primarily because … the savings have come on the backs of post-acute care,” Tanner said. 

For ACOs, DCEs, hospitals, and payers, here are a few takeaways and insights that emerged from their conversation. 

Transforming to Value Requires a Partner
“If you’re going to actually deliver value, you have to have some component of financial risk. [CMS] is desperate for providers to take that risk, right? But providers either don’t have the balance sheet or the actual wherewithal or desire to take it. And so we found that if we [as partners] can help the provider base get to a point where they feel comfortable taking risk, then they actually do the best job as it relates to doing the doing.” —Tanner

Systemic Change Takes Education and Incentives
“At these conferences, we like to think that healthcare has changed drastically. The reality is, the more it changes, the more it stays the same. From a post-acute provider perspective, a lot of the dynamics that we’ve been grappling with for five-plus years now are still the same dynamics. For example, hospitals fundamentally don’t understand post-acute care, yet that hasn’t changed our role. The role we play is to educate them at the system-level or service line or whatever level we can impart some education and knowledge that is helpful for them to do their jobs. The network—every hospital says they have a network, but they’re not driving significant volume, necessarily. Therefore, we actually put performance bonuses in our contracts. If a hospital hits certain metrics of the percent of their patients who are going to their network, they get a financial bonus on that network. So again, advocating for the highest quality providers while meeting your needs, where you win with volume, it also meets our needs, as someone who’s holding the risk. And so we have aligned financial incentives.“ —Fuller

Gains Come from Performance Transparency
“It’s a double-edged sword from our perspective—entities have to deliver. ICS has nurses, for example, in-market, that are rounding in skilled nursing facilities, they’re rounding with home health agencies. There’s a lot of eyes and ears on what you’re doing, on specific patient issues. We have to escalate some of those issues. We do that every day, actually. That feedback loop goes back to whoever the referral partner is, whether it’s a payer, hospital, or physician group. I think that’s the flip side, we’re trying to advocate for you, but you have to deliver because our accountability is back to our partners and being part of that feedback loop.” —Fuller 

Downstream Providers are Accountable
“We’re [OnPointe & ICS] probably the best at managing the chronically ill and knowing the price points better than any other industry in the United States. We’ve been doing it for 50 years. We know our costs to the penny, whereas others in the industry, you know, because they’re coming from a different perspective of investors have much fuzzier math, right? So my point is that we need to be able to tell our story on how we manage the chronically ill on how our interventions [make a difference].” —Tanner

Shorten Length of Stay with Efficient Discharge Planning and Well-Defined Clinical Programs 
“Discharge planning doesn’t happen on day one. There are so many process inefficiencies from the time a patient gets admitted to when we start discharge planning. Discharge planning inefficiency is something that we constantly fight against, and it creates a lot of elongated lengths of stay that are unnecessary in our mind…. If you’re holding risk, it’s CHF, pneumonia, COPD, and sepsis—that’s where you win or lose. And those are your highest volume conditions. Those are very complex, high clinical service line capability populations, and you need to build programs around them to differentiate.” —Fuller

‘Get in the Ball Game’ with Medicaid
“People often look at Medicaid as, ‘Oh, I can’t make it. There’s really no financial viability there for me to get in the weeds and work it.’ But states are hurting. States are making decisions to fund roads or education or Medicaid. And so as a localized, post-acute care operator, you can create some dynamic wins for the state as it relates to Medicaid risk. I think you’d be in the ball game there, too.” —Tanner 

Patients Can Gain a Trusted Advisor and Improve Service by Accepting Risk
“Healthcare is a terrible experience for the patient. Hospitals are motivated to get them out. They hand them an alphabetical list. You’ve got 24 hours to choose. That’s anxiety producing. They don’t know what, where to go, what to do. So I think having a trusted advisor there to navigate them through all of that is a welcome addition to the typical, very siloed, misaligned, incentives-run healthcare system from a patient or family perspective. Our patients get a nurse navigator for the entirety of their care, and that navigator is reaching out to them on average, once every three days. They have a care transition specialist also assigned to their care. They have a 24-7, 365 nurse hotline answered live by an ICS-employed registered nurse every hour of every day, regardless of what their anxiety or their issue is. So there are a whole list of added services that they get that no one else will provide. And quite frankly, the healthcare system doesn’t pay for those unless you’re taking risks somehow and you’re in, and you’re able to generate the savings to pay for it.” —Fuller

Read McKnight’s article about the session from the Synergy Summit. 

Additional Resources:

• Direct Contracting Entities: Get the Most Out of Your Commitment to Risk
• ACOs, It’s Time to Commit to Risk

ICS helps organizations transform from fee-for-service to value-based care and delivers ongoing care coordination, consulting, and expertise in data-driven processes necessary to achieve quality care and financial success. If you are an ACO, DCE, hospital, or payer in need of a partner with expertise in value-based care and proven results working with risk-bearing organizations, contact ICS today for a free consultation.

info@integratedcaresolutions.com
860-622-7645

Brian Fuller, CEO, Integrated Care Solutions 

Brian Fuller is the Chief Executive Officer of Integrated Care Solutions (ICS) and has held a variety of senior executive positions throughout his 20-plus year career in healthcare. His expertise is focused on value-based care, national consulting, and for-provider organizations that own and operate businesses across the post-acute, home, and community-based care continuum. Fuller is a strategist, skilled operator, and nationally recognized thought leader on post-acute care in new healthcare reform environments. He is a leading expert on care integration and partnership development across the continuum, including evaluating and implementing new payment initiatives such as bundled payments and ACOs. He is one of a select few to have successfully led provider and convener organizations participating with CMS, and served as an expert panel member to CMS. In 2017, he was named one of “Healthcare’s Rising Stars” by Becker’s Hospital Review.

Eric Tanner, CEO, OnPointe

Eric Tanner is the Chief Executive Officer of OnPointe where he has been working to transition the company from a traditional skilled nursing facility operator into a conduit connecting services, providers, and payers for the best patient experience and value. OnPointe develops systems of care that fill the gaps in the traditionally disconnected post-acute process. With a focus on the frail, elderly, and chronically ill, OnPointe delivers member satisfaction, systems management, and risk-based contracts. Tanner takes pride in OnPointe’s leading metrics that demonstrate to payers, providers, physicians, and patients how the company is transforming a broken delivery system. He is passionate about enabling a transformation in healthcare that stems from a desire to dignify humanity. Eric holds a B.A. in history from Stanford University.