Lessons Learned From the Yellow Brick Road to Value
An introspection on how value-based care initiatives and the 2020 MSSP ACO savings results have similarities to underlying political themes of “The Wonderful Wizard of Oz.” Get three expert ICS perspectives about the savings report and the future of value from the lens of hospital system management, CMS policy/strategy, and clinical patient coordination.
October 4, 2021
If value-based care were the yellow brick road, we’d be somewhere between the reality of Kansas and the fantasy of the Emerald City. Though there have been many interpretations of Frank Baum’s 1890’s work, “The Wonderful Wizard of Oz,” the underlying political allegories have settled on unrest.
Some political theorists believe the book’s veiled themes were about the disquiet of the 1900’s demonetization of silver. To fix it, America had to un-stake and shake the entire system for change to occur. Today, the same narrative could be told about healthcare.
On the yellow brick road of value-based care, we’re on our way to a shiny new, patient-centered, quality-rewarded healthcare system, but getting there is a journey either lined with gold or thwarted by loss.
As Dorothy and her friends eventually reached success, we can, too. For example, on our road to value, we are witnessing big wins exemplified by the 2020 performance data on the Medicare Shared Savings Program (MSSP). But do we stop there and claim success? Our experts think not.
You most certainly did not stop here for the Clif Notes on “Oz,” but we hope you stay for perspective from leaders in value-based care on how we have to remain unsettled on this journey in order to motivate us enough to get to the Emerald City.
Integrated Care Solutions (ICS) leaders are at the forefront of value-based change and innovation to guide accountable care organizations (ACOs) and other value-based organizations along the road to achieving quality metrics through patient-centered care coordination.
Perspective No. 1: Hospital System Management
Robert Millette, MBA, FACHE, is the newest member of the ICS leadership team as the Vice President for Delivery Innovation. Millette’s experience covers over 20 years in healthcare in senior executive roles for both large urban- and rural-integrated delivery networks, medical groups, and healthcare systems. In 2018 and 2019, he led a NextGen ACO to top percentile performance in the country, in both shared savings and quality scores. In 2020, he garnered a near max-level savings result in BPCI-A management, developing meaningful relationships around transitions of care, the physician specialist community, and the post-acute care continuum. His perspective is from the inside looking out. Here are his insights and learnings from the 2020 performance data.
“In what was a dismal year from a COVID standpoint, it was a bright point for ACOs. This report [The Performance Year Financial and Quality Results] doesn’t alleviate the need for continued work on alignment between healthcare systems, community providers, and payers to keep moving toward value-based reimbursement. The opportunities that were there in 2019 were not eliminated in 2020—we didn’t solve all of our issues. We’ve filled in more of the map. The road’s there, but we don’t know what’s on that road moving forward. We know we’re going north, and we keep making progress, but exactly which road we need to take for the shortest route to high-quality, lowest cost is still unknown. Organizations need to double down on their investments in their ACOs, including their partnerships, to be able to bring in different perspectives and optics as well as different models that have been proven in other organizations outside of the calendar year 2020.
Moreover, the focus moving forward must be on quality. If you lead with quality, the finances will follow. Even with these successes, the pain areas for many ACO executives and health system leaders include figuring out how to successfully micromanage complex patient transitions throughout the continuum while aligning all of the players involved in a patient’s care. With a partnership in innovative, community-based care coordination, the pain becomes peace of mind.”
“If you lead with quality, the finances will follow.” —Robert Millette
Perspective No. 2: Policy & Strategy
ICS’ CEO Brian Fuller provides unique angles on policy and strategy 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 ACOs and Direct Contracting. 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. From his perspective, ACO savings indicate that now is the time to band together with a strong network.
“For 513 MSSP ACOs, collectively producing $4.1 billion in gross savings and $1.9 billion, after accounting for shared savings payments, is a giant feat. Also, notably, these ACOs garnered an average quality score of 97.8 out of 100. These results are not in question, but is this feat repeatable? Do ACO executives know how they got here, can they mirror the same actions in the years to come to achieve similar results? As Robert said, COVID caused a dismal year for healthcare in general, but ACOs did exceptionally well. Why? What this leap from the previous year (where ACOs produced $2.6 billion and $1.2 billion in gross and net savings) tells me is that it’s time to band together. There’s no time like now to actively surround yourself with experts that know how to unravel complex payment models, coordinate care hands-on in post-acute and SNF settings, improve processes with cutting-edge technology, fine-tune risk stratification, and complement vertical expertise with horizontal integration. Make sure someone is assigned to analyze the devil in the details and micromanage every high- or rising-risk patient so you can truly know what works and what doesn’t so missteps can be avoided and successes can be repeatable.”
Perspective No. 3: Clinical Patient Coordination
Our third perspective comes from Andrea Rizik, RN, ICS’ Vice President of Clinical Integration and Clinical Operations. As a post-acute clinical operations specialist, she has developed disease-specific specialty programs with clinical care pathways and has overseen case management and care transitions across multiple organizations. Her clinical integration expertise was honed through comprehensive leadership roles connecting patients to the most appropriate setting and tightly managing care, leading to improved quality and optimal outcomes.
“For ACOs to continue success at the clinical level, patients must be micromanaged to prevent readmissions. For that to happen, we can’t emphasize enough that discharge planning—or as we prefer to call it, care transitions planning—must be prioritized. The process requires exceptional communication and ‘warm handoffs’ across care settings. Our mantra is that ‘discharge planning starts upon admission.’ Every aspect of the patient’s needs—physical, social, and emotional—are taken into account through the transition. Very early discharge planning helps in setting realistic expectations, aligning on goals based on the medical and therapy prognosis, involving family and caregivers, and establishing an approximate date of transition to the next level of care.”
To quote Dorothy: “Toto, I’ve got a feeling we’re not in Kansas anymore.”
And that’s a good thing because ACOs are leading the charge to unsettle the system. There still is a yellow brick road to journey, but we’re moving forward. That once fantastical idea of value-based care isn’t so extreme after all.
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.