Leadership Symposium: Leaders​ navigate​ the​ bumpy​ road​ to​ value-based​ care

Mark Ganz, CEO of Cambia Health Solutions; Tom Jackiewicz, CEO of Keck Medicine of USC; and Kate Walsh, CEO of Boston Medical Center.

All aspects of the continuum of care are changing. Technology, policy, payment, care delivery and providers' relationships with consumers are vastly different than they were 10, or even five, years ago. C-suite leaders face challenges including implementing value-based care, establishing population health efforts and creating mutually beneficial partnerships. On Oct. 19-20, Modern Healthcare gathered executives for its second annual Leadership Symposium, in Paradise Valley, Ariz. The goal was to help shed light on the journey to value-based care. Systems have taken vastly different paths.

One session, moderated by Ceci Connolly, CEO of the Alliance of Community Health Plans, featured Mark Ganz, CEO of Cambia Health Solutions; Tom Jackiewicz, CEO of Keck Medicine of USC; and Kate Walsh, CEO of not-for-profit Boston Medical Center.

Connolly began by noting that the program for the invitation-only symposium described value-based care as less a sprint than a triathlon and acknowledged that the industry needed a little push. She began by asking how financial carrots and sticks were playing into the organizations' transformation efforts.

Ganz: I think people use money as an excuse to not change. "If I don't get paid, I won't do it." When you get to know the patients, getting paid is less important. I think payment accelerates innovation but rarely is payment itself an innovation. Payers should be attentive to that and both providers and payers need to be less about controlling and setting up rules.

Jackiewicz: USC bought these hospitals from Tenet back in 2009 and it was clear to me that we needed a revolution in culture. We were in a very fee-for-service mindset. So we engaged Vanderbilt University to help increase physician engagement. And now we think about pre-op and post-op care because we want to make sure that we're aligning the services that we provide with what the patient expects.

How​ are​ you​ incorporating​ the​ patient​ into​ value-based​ care?

Ganz: About eight years ago, we started investing in palliative care, which at its best is not end-of-life care. It begins at diagnosis and continues with the curative team whether or not a cure is effected, because even achieving a cure can be tough on patients and families. So rather than start from the perspective of our legacy not-for-profit health plan, we started with our foundation. We partnered with health systems. We would pay them. And it started from the perspective of what people want. The risk we took was that administrators wouldn't fund the programs, but in 100% of the cases, they were so popular with families that they have become part of the health system.

Walsh: We're a health system that owns a Medicaid risk plan and is at full risk for the Medicaid population we serve. In our case, 3% of the population is 40% of the spend, and finding those patients where they live, which could be under a bridge, will require a different kind of engagement.

How​ are​ you​ making​ sure​ you're​ using​ the​ right​ quality​ measures?

Ganz: When I became CEO about 14 years ago, the Blue Cross and Blue Shield Association had this national metric that was very transactional—like, how fast do you answer the phone and how fast do you get off the phone? Now, there was wisdom in this idea, which was about efficiency. Well, a strange thing happened when the phones got busy. Some people figured they could pick up the phone and drop it. There was no wait time and the talk time was zero. Today, our metric is NPS, Net Promoter Score. It's basically how many people hate or love you. I think moving from the transactional "we are smarter than you" measures to "what do individuals really care about" was transformative.

Walsh: We report over 440 measures to 30 different agencies every month. Our Medicaid ACO requires 39 quality measures that are actually a gate to receiving any bonuses, so failure is not an option. So 30% of the people we're hiring will just collect data so we can get paid. The other imperative for fixing this is physician burnout. We're turning the most highly trained workforce into data-entry operators.

How​ are​ employers​ revolutionizing​ value-based care?

Jackiewicz: Employers want quality metrics. They are focused on quality because they are paying for it and they want fewer sick days and happy employees. The employers, which are our best payers, are going to drive us to change because they are running results-oriented businesses.

Walsh: One of the wake-up calls I've had is how we deal as an employer with substance use disorders. Most insurance plans pay for limited treatment only, including our own plan. So we started with a no-questions-asked pickup of Narcan in our employee pharmacy, and the uptake was stunning. And to think that Medicaid probably pays for 30% of the substance disorder treatment in the country and the program itself is under assault so we'll have trouble addressing the opioid crisis. We need to start thinking that our patients' problems are our problems, and our families' problems, too.

Is​ Washington,​ D.C.,​ helping​ or​ hurting​ the​ transformation​ to​ value-based​ care?

Ganz: Government, in my opinion, is not an innovator, but it can be. It's a great imitator, and it can be an accelerator. But it's a mess right now and you wake up every day and worry about what's going on there. I think that the innovation that's long-lasting is going to happen in the trenches. The smart companies aren't paying too much attention to what's happening in D.C. They're focused on driving value.

Jackiewicz: Nobody's going to pay more for healthcare. Just look at the national deficits. So we've got to bring our costs down and we have to focus on our patients and our quality. Just focus on your basics and you'll be OK.

Walsh: I agree. I think the instability and the lack of civility in the public discourse doesn't help anybody. But I think this industry really can heal itself.

How​ should​ hospitals​ deal​ with​ the​ fact​ that​ if​ they​ stop​ putting​ bodies​ in​ beds,​ they're​ cutting​ into​ revenue?

Walsh: Well, for us, fee-for-service Medicaid is no way to make a living, so we'll try anything. But the revolution is really aligning the payer and provider, which is what our Medicaid ACO aims to do. There could be unintended consequences to full-risk capitation in a state like Massachusetts.

Jackiewicz: About 50% of our patients can be served in a community hospital with basically the same outcome and lower cost. As an academic center, we want to provide the complex care and move the less complex care to a lower-cost setting. Bundles are an opportunity for us. If we price ourselves competitively and deliver the highest quality care, we'll be very successful.

Modern​ Healthcare's​ Leadership​ Symposium​ is​ an​ invitation-only​ event.​ To​ request​ an​ invitation​ for​ 2018,​ visit:​ ModernHealthcare.com/2018LeadershipSymposium.