Payment & Delivery Models

3 must-do’s for the move to value-based care

Editor’s note: The North Carolina Department of Health and Human Services (NCDHHS) has suspended the state’s move to Medicaid managed care citing the state legislature’s failure to provide “required new spending and program authority for the transition.” The North Carolina General Assembly passed legislation in 2015 directing NCDHHS to start the transition.

The U.S. health care system is moving toward value-based care, but a consensus on how to define and measure “value” in health care has proven to be elusive. Participants in an AMA-convened panel all had their own ideas on that question, but common themes emerged on how physicians and the health care system can move ahead.

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Representatives of different industry sectors talked about what was important to them during an AMA-sponsored ReachMD podcast, “Value-Based Care: Taking the Pulse of Key Stakeholders in Healthcare,” which is part of a special series of programs on “Reaching the Potential on Value-Based Care.”

In the podcast, Kathleen Blake MD, MPH, the AMA’s vice president for health care quality, cited a University of Utah/Leavitt Partners survey on how patients, physicians and employers defined value.

Patients most valued quality—as measured by efficiency, effectiveness, safety and outcomes—and cost followed as the next-highest consideration, according to the survey. Physicians held similar views, while employers’ highest priorities were affordability and access to high-quality physicians.

For Sheila Savageau, U.S. health care leader at General Motors, value is defined “as improvement in the member experience.” This includes more engagement, better quality outcomes, and improved efficiencies in the health system. Three take-home points emerged from the discussion.

Need to align on values

Savageau noted something that was a common theme among the panelists—that the incentive to improve value, no matter who is defining it, will have positive effects elsewhere in the system.

Michael Ceres, CEO of 11 Health and Technologies, also participated in the panel. He founded his company while recovering from an intestinal transplant that required an ileostomy. 11 Health offers an FDA-cleared ostomy management system. For Ceres, value-based care is about outcomes—but added that people can have different perspectives on what equals a successful outcome.

“Some of the challenges around the move to value-based care are that outcomes are quite personal,” Seres said. “If you can understand what outcomes are important and align those outcomes between provider and patient, you will get better quality outcomes, but also you will probably get better cost efficiencies because you are more aligned.”

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Measure smartly to get better

“Data is critical to how we track the quality outcomes, what the physicians are seeing, what the health systems are seeing, and really has to improve upon that,” Savageau said, adding that employers can use the data to find gaps in services.

“There are two things that physicians need to know,” Dr. Blake said. “Know the data about your patient population and know how to use it to drive improvements.”

Savageau said GM uses data from National Quality Forum measures and the Consumer Assessment of Healthcare Providers and Systems Clinician and Group Survey.

“What we find is the physicians in the health systems are in a very difficult position as they are asked to track measures from a variety of sources,” Savageau said. “And the complexity can be quite significant.”

Be ready for change’s challenges

There is no switch to flip that will automatically change the health care system from fee for service to value-based care.

This month, North Carolina begins the transformation of its Medicaid program that includes Medicaid managed care contractors operating as “prepaid health plans” that the state will delegate with management of certain health services and financial risk.

Mandy Cohen, MD, North Carolina Health and Human Services Secretary, explained that the state Medicaid program aims to be more proactive.

“One of the biggest challenges we’re facing is that change is very hard,” she said. “As we move to value, we are trying to think about how do we proactively keep our communities and our state healthy. That’s a big change.”

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Dr. Blake said the AMA will help by forming partnerships with patients and other groups, conducting research on challenging issues such as behavioral health integration, piloting solutions, and providing physicians with educational resources.

“The AMA's key objective is to prepare physicians to lead and succeed in a high-performing health care delivery and payment system, one that advances quality and cost objectives,” she said. “The AMA wants to know your story, your successes, your challenges, and we want to know what works, and to have you suggest to us where we should focus our efforts as we all work together to create a more effective, satisfying practice of the future.”