Payment & Delivery Models

Value-based care work leads to health improvements in Michigan


Benji Feldheim

Contributing News Writer

AMA News Wire

Value-based care work leads to health improvements in Michigan

Jun 24, 2024

Henry Ford Health has experienced growth in an innovative direct-to-employer, risk-based contract with General Motors (GM)—one of several ways the Detroit-area health system is applying value-based care in practical and effective manners. 

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The value-based program, ConnectedCare, was launched in 2019 and required Henry Ford Health to hold costs under mutually agreed upon annual limits, while also meeting 19 quality, cost and utilization targets.

Member months—the number of people participating in a plan each month—in GM ConnectedCare grew from about 76,000 in 2019 to about 117,000 in 2023. This represents a more than 50% increase in member months for GM ConnectedCare between 2019 and 2023. And it represents about a 3,400-member increase over that period.

“Employees found they are paying less out of pocket and are experiencing better outcomes,” said Adnan Munkarah, MD, chief clinical officer at Henry Ford Health, where he also is president of the care delivery system. “We saw improvements in management of hypertension and diabetes, as well as musculoskeletal and obstetrics care. We renewed with GM for another five years as a result.”

For 2022—the most recent and complete performance year—there was a nearly 10% increase in the rate of blood pressure control for members with hypertension compared to 2019, which was the original year of the contract. And over the course of the five-year contract, there has been an average annual improvement of nearly 3% from 2019 to 2023 in the rate of blood pressure control among members with hypertension.

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The GM program is among several efforts by Henry Ford Health to take the concepts of value-based care and apply them in ways that lower costs and improve patients’ health, all without adding more burdens for physicians. But these accomplishments did not happen overnight. 

“We entered into value-based care about 20 years ago. At that time, it stemmed from our belief that we need to provide better coordination of care rather than having a transactional relationship with the patients,” said Dr. Munkarah. “We have learned over time that in order to provide value-based care, you need to have the right team. You need to make sure to have the needed data and analytics. You want to make sure that you are providing the access, and you need to engage patients.”  

“When we enter into a new contract with a payer, we mobilize our population health services,” said Dr. Munkarah. “We ensure that patients have the appropriate access to care and start implementing early interventions. We want to move care upstream and not just wait until the patient is sick.”

The coordination also includes providing outpatient primary care—in person or virtual—and urgent care as appropriate instead of unnecessary emergency department visits. Henry Ford Health is also making sure that patients who are undergoing surgical procedures are set up with optimal preoperative preparation and well educated on steps for accelerated recovery. 

“There are a lot of times when being able to provide rehabilitation at the patient’s home is best for their situation,” said Dr. Munkarah. “We’ve developed the capabilities to offer the best care possible at the most appropriate location.”

A key element of Henry Ford Health’s approach has been to work with nonphysician providers, medical assistants, care managers and other health professionals to develop these comprehensive approaches. 

Henry Ford Health established as many access points as possible for care, enhancing availability for primary care, both in person and virtually. Paramedics are also available to check on patients at home after they are discharged to avoid readmission. Education programs have been developed so patients understand their role in their own care, and what practices they need to be responsible for to have better outcomes. 

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Understanding social drivers of health allows Henry Ford Health to take care beyond their locations’ walls and into their nearby communities. Coordinating with local support services such as those offered by community or religious organizations and counties is also important to finding the best approaches for the most patients. 

“When we talk about managing high blood pressure, and the only nearby food source is a fast-food store, then that won’t help the patients on their journey,” said Dr. Munkarah. “If we know that about their situation, we can work to find a solution early on.” 

Henry Ford Health created a targeted survey to identify the social drivers of health for their patients and developed a process to connect them with available assistance. The State of Michigan soon after created a platform to connect patients who have specific social needs to community resources. Henry Ford Health has been able to tap into this statewide approach.

“We have been very focused on this,” said Dr. Munkarah. That’s because 80% of the clinical outcomes can be impacted by social drivers of health. 

Henry Ford Health is potentially on the hook to lose money through arrangements such as the GM risk-based contract. But by analyzing patient data to find the highest risk people and the right solutions for a broader array of patients, they can stay ahead of pitfalls and, more importantly, improve outcomes. 

“We need to make sure that all the information in electronic health records can be accessed by the care team in a simple and straightforward manner,” said Dr. Munkarah. “This can be complemented by clinical decision systems that help the physicians understand the patients’ needs and optimal care pathways to ensure best outcomes. Making sure they’re not ordering unnecessary tests, or repeating tests that have already been completed, is one example of this in action.”

Additionally, Henry Ford Health has dedicated resources toward educating physicians and other health professionals and giving them support to learn how to use various information modules, including access to case studies. 

Taking this approach into an accountable care organization with the Henry Ford Physician Network, the Jackson Health Network and Saginaw, Michigan-based Covenant HealthCare, the collective group saw reduced costs within the first year. Together, the groups saved about $14.3 million in health care costs in 2022 by using an array of efforts to improve care. 

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Specialists are also an important part of how Henry Ford Health care teams have worked to close the gaps in care. Notifications alert a person’s care team if, for example, they are due for any type of cancer screening and appointments can be set up to be proactive. 

Additionally, the system’s neurosurgery and orthopedics teams developed a “prehab” for spine and joint surgeries. “Before the procedure, the patient gets educated about things they need to do and exercises that they need to perform prior to their surgery, and then after they have completed the procedure so that the recovery is faster,” said Dr. Munkarah. “Home health can also play an important role in the recovery process. We’re also developing this for cardiovascular disease and maternal health to lessen readmissions.”

Taking a team-wide approach to managing care has gone a long way to ease administrative burdens at Henry Ford Health. By dividing and delegating among nonphysician providers, nursing staff and managers, and community health workers, plenty of support exists to sort through intricacies of insurance, including prior authorization. 

“We have administrative support and education on coding and documentation to support the providers in capturing the needed clinical information and facilitating prior authorizations,” said Dr. Munkarah. 

Henry Ford Health has also implemented a specialized team to specifically handle prior authorizations, including communicating with insurance companies and proactively updating physicians of any process changes. 

Dr. Munkarah shared that other health systems have used comparable approaches to Henry Ford Health. He stated that the journey for value-based care will advance with patience, perseverance, sharing the learnings and continued improvements since different populations might have different needs. 

“This is a journey, and it takes time and there are bumps along the road,” said Dr. Munkarah. “We believe strongly at Henry Ford Health that a national system with only fee-for-service care is not sustainable in the long term. It's not providing the clinical outcomes or the quality of care that we need. 

“We also think that the physician’s voice needs to be heard. The physicians need to be at the table in planning future value-based contracts, working with both CMS and insurers to find the right solutions, he added. “Thankfully, the AMA has been pushing for this and it’s showing benefits.”

Learn with the AMA about ways to improve value-based care data sharing and best practices for payment methods