Angie Stewart:
Hello, and welcome to Healthcare Insider, a sponsored content podcast series from Modern Healthcare Custom Media. I'm your host, Angie Stewart, and today we are speaking with Kevin Coloton, founder and Chief Executive Officer of Curation Health, and Dr. Matt Lambert, Chief Medical Officer of Curation Health. Kevin formed Curation Health after seeing the challenges providers experienced in their transition from fee for service to value-based payment models. Dr. Lambert is a board-certified emergency medicine physician with more than 20 years of clinical experience and a leader in value-based care.
Before we dive in, we'd like to thank the sponsor of this episode, Curation Health. Curation Health is powering a smarter, simpler path to value-based care with a market-leading technology platform that curates and delivers relevant clinical insights to physicians and care teams, enabling partners to successfully navigate and scale from fee for service to value-based care. Today, we are talking to Kevin and Dr. Lambert about how providers can be successful in value-based care, including how to address the biggest barriers in their transition.
Thank you both so much for being here today. Value-based care is a complex reality and a challenge for our audience, so we really appreciate your insights.
Matt Lambert:
Angie, thank you so much. We're very excited to be here.
Kevin Coloton:
Thank you, Angie. It's great to be here. I'll start with that. I'm a longtime reader and huge fan of Modern Healthcare, and it's an honor and privilege to be speaking with you today.
Angie Stewart:
Kevin, can you tell us a little bit about yourself and what inspired you to create Curation Health?
Kevin Coloton:
I started my career as a physical therapist doing bedside care, and quickly moved on to do entrepreneurial ventures, healthcare consulting, healthcare administration, and then, ultimately, settled on some time in the technology side of healthcare, enabling complex technology systems to be easily used by providers. And, when we started this journey at Curation Health, the focus was understanding how fee-for-service physicians are migrating to value-based care and the real headwinds they face with trying to make that pivot.
It's not easy. I think there's a real assumption that the only thing that's different is the type of note a physician writes and the code they select. But we understand the infrastructure of a fee-for-service approach is very, very different than the infrastructure required to have sustainable success in value-based care. We sought out to create technology to make that easier, remove those headwinds, take away some of that inertia, and make it easier for providers to do what they love doing, which is elevating the care of their patients.
Angie Stewart:
That's fantastic. And you mentioned there are many challenges with value-based care. What would you say is the biggest barrier for those transitioning to value-based care?
Kevin Coloton:
I think it's such a complex question, and I think we could spend several hours on that one question, but when we approach a new organization looking to expand or start their value-based care journey, the challenge is value-based care is very different than they've traditionally structured their processes, their workflows, their information management, their provider engagement, their care team activities, and I think the assumption is that they just need to write a different type of note. What we see is the big transition from fee for service to value-based care is best defined as a pitcher and a catcher in a baseball analogy. In fee for service, most of the outpatient activities are reliant on patients scheduling an appointment, coming to the clinic to see a provider to manage a care need, and in that visit, typically, great providers often cover more than just that specific need to elevate the care of the patient.
In value-based care, instead of the receiving of a visit, it's reaching out to engage patients to see them across an annual year continuum to make sure they're comprehensively managing all of the acute and chronic conditions that exist and the patient is challenged by, and often, that takes more than one visit. It's being prospective to try to understand when do these patients need to be seen, how much time do I need to see them, and how frequently do I need to see them across the next 12 months to be able to manage their care needs, but also have enough time and capacity to cover all of the items and issues that need to be managed by that?
Angie Stewart:
To distill that, it sounds like this is really about being proactive versus reactive. Dr. Lambert, do you have any follow-on thoughts there?
Matt Lambert:
I do, Angie. Thank you. Yes, it's a care redesign, I think is the best way to say it. Traditionally, in a fee-for-service world, you can just get bigger, and we see a lot of merger and acquisition across all segments of healthcare today, but to really do value-based care well, and to move into it, you need to change the way you deliver care. And that's from registration to the care team to the way your providers think about proactive care. To Kevin's point, there is an element of how you present that care and how you document on that care, but you also have to think differently from a rev cycle standpoint. And, certainly, as Kevin and I have been the technology space of healthcare for such a long time, least of all, it's a technology problem. It is a care redesign challenge, and there are some ways that we've learned that you can tech enable that.
Angie Stewart:
Knowing those challenges, what are the keys to early success in value-based care?
Kevin Coloton:
Angie, I think this may be where Dr. Lambert and I philosophize a little bit. This is a really important question is how do you start, either how do you start a real expansion into value-based care if you've already been on the journey for a while, or how do you initiate a value-based care program when you haven't done it historically as an organization? And I think this pertains to both health plans, or health insurers, and provider organizations. And I think the biggest mantra we consider when we're working with an organization starting is think big, start small. It's really important to have initial steps that build the infrastructure you need to have sustainable success.
And Dr. Lambert, in a previous question, touched on this is not a technology problem. The natural tendency is to acquire an armada of analytics tools and technical gadgets and gizmos to be able to assess and analyze all of the information available. And it's really interesting, I started my career and moved into technology and spent a few years as the healthcare CIO for a retailer. And they had been doing data management for decades, and the goal of their data analysis was what's the smallest data set that I can cultivate to deliver to the end user that provides them success and sustainability?
And, in healthcare, we're earlier in that journey. When you think about the deployment of major electronic medical record platforms, it's been across the last 20 years. Instead of 50 years, it's 20 years of knowledge. And I think we frequently get caught in this data maximalism mindset, which is look at all of the information we have at our disposal, and all of the potential value in that data is very exciting. The challenge is taking that massive data set, and no pun intended, but curating it down to a very small data set that's highly actionable that allows the end user to be successful. And I think in the healthcare technology industry, we frequently forget that it is legally required that a human is part of the value-based care chain of events. A physician needs to write a specific note and an accurate code, and all of our technology workflows and approach should be designed to enable that important activity to happen with the least amount of inertia.
Think big, start small is think about all of the potential value-based care may provide to your organization, all the value it can create. It's a very different revenue cycle equation as well as clinical workflow equation. But start small by emphasizing simplicity. How do we get a very simple data set to start with? How do we focus on the fundamentals of value-based care in year one and then expand after you get those fundamentals fully engaged and captured? How do you provide the right support for providers? I think there's a tendency to just say, "Hey, we have this new contract, go get them." The physician is trained on a historical model, asked to do a very new model. Without the right support, it can be overwhelming and engagement suffers, and it's very hard to recover that excitement or engagement unless the right support structure's in place. We consider this mantra of think big, start small to be particularly important in this transition to value-based care.
Angie Stewart:
That's great. And we're going to come back to the idea of a support structure, but, Dr. Lambert, would you like to weigh in on keys to early success in value-based care?
Matt Lambert:
Yeah, Angie, during my time as a chief medical information officer, I've distilled my responses down to answer number one and answer number two. Answer number one is no, answer number two is keep it simple, and I think that's translated very well to value-based care as well, the four pillars of talking about improving outcomes, reducing cost, improving the patient experience, but also improving the provider experience. And so I think this can be a nice transition for providers who are used to really being on a treadmill, a fee-for-service treadmill. Give them some more time with their patients. Let them think a little bit more holistically. Let them develop a little bit more of a relationship with their patients.
Set up your delivery model that way. Think of a creative way to work this into the compensation model, knowing that that's a tough road to hoe. Your compensation model will change a lot, especially early on, but try to think of a simple model that really incentivizes spending more time with your patients and thinking a different way with your patients, and also concentrating on the things that the folks went into healthcare for anyway, preventive care, compassionate care, and focusing on the basics first, and you'll find that you'll get more sophisticated and grow over time.
Angie Stewart:
How does Curation Health support their payer and provider partners moving into the space?
Matt Lambert:
On the payer side, and I'll use the tech term, the middleware between payer and providers has really been an enlightening place to be and we've learned so much from that. But to help put the payers to be able to be at the point of care in the electronic health record is something that is very valuable to them and it allows us to interact with payers and providers in really a new way, pulling this information forward. The other thing that's a big value-add to our payer partners is without being dependent on a claims loop, in other words, a 90-day delay in knowing where you are with the care for your members, and I'll switch to payer speak for a moment, where they are with their members, to be able to know, the day after the visit sometimes, of where they are in their care journey is very, very valuable on the payer side.
On the provider side, to have additional insight outside of your primary purview, in other words, information that's happened outside of your health system, outside of your care area, outside of your electronic health record, is often very valuable as well. And then Curation Health to be the translators, I think, between, and we're going to talk about it a little bit more later on and some of the big changes that are coming from CMS, to be the translators of that and to take that cognitive load off of the provider and say, This patient's at a value-based care program. We have some priorities that we need to address." They don't know if the patient's at an ACO. They don't know if they're in Medicare Advantage. They don't know if they're in ACO REACH program. For us to distill that down, and as Kevin put it earlier, to minimalize that data to what is really the most important is a big add for providers, and we free them up to just provide care and not have to worry about what changes or what might be the [inaudible 00:12:25] of a contract.
Angie Stewart:
Kevin, what are your thoughts on how Curation Health supports payer and provider partners moving into value-based care?
Kevin Coloton:
Thanks, Angie. When you step back from the arena of value-based care where the event is happening and you're watching it from the stands, it is really complicated, truly complicated, for a provider or a plan to harmonize what's happening at a contracting level and what's happening in the room with a patient and making sure there's value being created across that whole continuum, the health plan is receiving full credit for the great work of their network, the provider is receiving full credit for the great care they're delivering to the patient, and, ultimately, the promise of value-based care is the patient is receiving comprehensive health assessment, diagnostics, and treatment. And to make that harmonization work requires massive simplification, but that stakeholders have various interests and expertise. Our job is to be the nexus between them to harmonize the value and the simplicity so the information can flow both ways, both from a plan to a provider, from a provider to a plan, so all value is being received by the appropriate stakeholders.
And Dr. Lambert alluded to a concept we obsess about at Curation Health, which is data minimalism. What is the minimum data set that needs to flow through that equation to have all stakeholders win, patient, provider, and health plan? And, candidly, that's the master level education is being able to sift through this massive amount of information and make it simple. I think they require different information at different times, but that simplicity is what we obsess about. An example would be how do we understand how many contracts a provider organization may have? They may have four or five different health plan contracts, and often they're challenged because everyone is trying to help.
Every health plan is supporting a solution or a portal or an app or a tool to be able to capture as much information as they can, and those are innocent and positive investments they're making on behalf of the provider to help them do their work. The unintended complexity of that, though, is a provider then has to choose which path they use for this particular patient mapping to this particular managed care contract. That example, what we aim to do is to simplify that, say regardless of what health plan, what contract, what subcontract you have, you just have one workflow. It's a Curation Health value-based care workflow, which is embedded in the electronic medical record that that physician prefers to use to do their work. And we make it as simple as possible for them to achieve all of the activities that need to be completed and then be able to disseminate that information to the partners in that equation to make sure everybody has knowledge of what occurred and the value that was created across that continuum.
Angie Stewart:
Right. With all of the challenges we've discussed already, it really is critical to have that support you described. Dr. Lambert, if you could only give one piece of advice to a new value-based care partner, what would it be?
Matt Lambert:
Angie, that would be patient. I know those aren't words that you often hear in the healthcare space, but this is an 18-month journey and there is no easy button, so there's no substitute. You're, you're essentially changing everything from registration to bill. You're changing the way you engage patients, the way you do outreach to patients. You're changing the way your care team thinks about exchanging information, sharing information, thinking of efficiencies wherever they can find them. You're asking your providers to deliver care in a slightly different way, probably in a way that they weren't trained to do with a tool that wasn't necessarily designed to do that. You're asking patients to receive care in a different way and to look at ... and so it takes 18 months for everyone to go through their change process associated with that.
Unlike fee for service, the way these contracts are set up, you're not going to see a change to your bottom line for about 18 months anyway. There's a feeling that you're paying in and you're paying in and you're not seeing that ROI right away, but that's how long it takes for these to mature and to come back around. I know those might not be the easiest words to say or the most popular words to say in some cases, but if I was going to say it, I would say be patient in your transition to value-based care.
Angie Stewart:
That's a great piece of advice. Kevin, do you have anything to add?
Kevin Coloton:
Thanks, Angie. There is one point I would like to add. I think be patient is really important. You said one piece, I'm going to give two. First one is I really want to reiterate the keep it simple. Start with fundamentals. It's really hard to do advanced value-based care if your providers haven't been brought along on the journey and engaged in the continuum. But I think the other one is, Dr. Lambert highlighted it, there's no easy button. I think people are searching for some tool or technology that just makes value-based care work universally. And there's great technologies, I would submit we have really advanced and great technology, but it's a campaign approach is required to transition an organization to value-based care, providing the right support, providing the right technology, and providing the right engagement support, so providers are seeing this as an opportunity to transition to a different type of medicine, some would argue a more sustainable type of medicine.
But having the right level of support to complete that journey without stress, or a tremendous amount of stress, and without a lot of challenge is a key priority here, and I think that weaves right into the be patient is that it takes a while. Change management just naturally takes a long time, and we're asking providers who are massively talented and highly expert in what they do to do it differently. And they've been, in some cases, been doing a workflow for a very long time. That support and time is really valuable.
Angie Stewart:
Right. It sounds like support, simplicity, patience, all essential to success under value-based care. My next question is related to some recent news. Dr. Lambert, what are your thoughts on the CMS final rule recently issued for Medicare Advantage in 2024?
Matt Lambert:
Well, Angie, in line with Kevin's previous answer, I know we talk about one rule more than the other, but there are actually two rules that came out in Q1. I want to address both of those. And it was really a time for bold action from CMS. A first was how CMS might audit any risk adjustment to bills sent to CMS, and this was four years in the making, we knew this was coming, but they're emphasizing that anything that is passed from a Medicare Advantage organization to CMS has to be validated, has to be on an encounter and supported in the electronic health record.
And Kevin and I, as Curation Health has been growing over the years. We didn't know there was another way to do it other than to present quality information to a provider, ask them to exercise their clinical judgment on it, and record it in the electronic health record before it becomes submitted. We think we are well positioned when it comes to what they call RADV audits, not only for ourselves, but also for payer and provider partners. We think we're in a good position when it comes to that.
The second piece that came out not long after that was some substantial changes to the Medicare Advantage reimbursement program and to the risk adjustment program, and these are the most significant changes that we've seen in, oh, I'll just use a dozen or so years, to the risk model and the way they handle some of these risk scores and reimbursement patterns. It is a clear signal that they are trying to get the cost of care for Medicare Advantage patients more aligned with fee-for-service patients. And so they're trying to have a 3% reduction in '24, and I think that we'll see that decrease a little bit more over time.
These are significant changes that we're going to be working with our payer and provider partners to get through this, but it is clear they're trying to decrease some of the payments for these spaces and they're doing this by changing the risk adjustment model associated with that. They came out with a preliminary rule early on and, essentially, very swiftly produced a final rule not long after that with very little changes associated to it. The most significant change to it, Angie, was they decided to phase it in. Instead of delaying a year, they're going to roll it in in a way that actually adds some more complexity. And so we see that as an opportunity to help shepherd our payer and provider partners through this change using our team, using our expertise, and using our technology to help define what the new space is going to be like. But big changes on the way in the Medicare Advantage space.
Angie Stewart:
Absolutely. Kevin, any thoughts to add on the bold moves by CMS lately?
Kevin Coloton:
Dr. Lambert's summary is very sound. In addition, think he made a comment about we didn't know there was another way, I think one of the challenges is, in the evolution of value-based care, there's been a lot of attempts to use technology to do things in addition to what the provider's doing. And we have always felt like the provider is the quarterback of this equation is the highest value for the patient and the whole clinical process, and providing them the right information at the right time and allowing them to act both maximizes the value to the patient and the provider, but also is probably most appropriate from a compliance and a integrity of the workflow perspective. We've always subscribed to that workflow, but we think we're really well positioned as there's more attention being placed on those activities.
Angie Stewart:
Excellent points and certainly lots to watch in the coming months and years. Kevin, Dr. Lambert, this has been an excellent conversation. Any final thoughts for our audience before we wrap up?
Kevin Coloton:
Thanks for the opportunity. I know there's a lot to explore in value-based care, especially in our domain of value-based care, which we define as prospective risk adjustment, which is getting the information to the provider at the point of care to guide some of their focus. And there's a tendency to want to just find solutions that make things easier, and I think we are seeing organizations make huge investments in technology and workflow and support. We're excited about that. We continue to believe value-based care is a great answer for how do we move our outpatient care to the next level and provide increased value to patients. And thanks for the opportunity to overview some of our philosophy on this topic.
Angie Stewart:
Kevin, Dr. Lambert, thanks so much for speaking with us.
Matt Lambert:
Angie, thank you so much for having us today.
Angie Stewart:
This has been a sponsored episode of Healthcare Insider, created in collaboration with Curation Health. For more information about them, please visit www.curationhealth.co.
I'm your host, Angie Stewart, content strategist for Modern Healthcare Custom Media. Look for more episodes of Healthcare Insider under the multimedia tab at modernhealthcare.com or subscribe to your preferred podcatcher. Thanks for listening.