Lumeris is celebrating a significant achievement this month as one of its clients, Essence Healthcare, has recently attained a rare Centers for Medicare and Medicaid Services (CMS) 5-Star rating for the quality of services it delivers to its Medicare Advantage plan members. Essence Healthcare is a unique success story because the health plan earned this distinction without owning hospitals or employing physicians. We helped Essence Healthcare achieve a perfect rating by engaging and rewarding physicians, integrating data from across the continuum of care, and helping physicians incorporate best practices into their daily workflows. The 5-Star rating demonstrates that quality outcomes and positive financial results can be achieved simultaneously. Our model is scalable and can benefit any healthcare organization in the country with similar goals.
This accomplishment comes just weeks after I had the opportunity to lead a panel discussion with some of Nashville’s most distinguished healthcare executives about value-based care and how they are making that transition within their organizations.
Panelists included Jason Dinger, Ph.D., CEO of MissionPoint Health Partners; Victor Giovanetti, Western Group president of LifePoint; Jeffrey Guy, M.D., CEO of TriStar Health; and Lynn T. Simon, M.D., MBA, president, clinical services & chief quality officer of Community Health Systems. All panelists are actively engaged in designing population health strategies for their organizations. They shared their experiences as they work to make accountable care a reality. Several themes transpired during the discussion:
1. Transitioning to value-based care is different for everyone
Markets are evolving at different rates. In some areas, organizations are actively pursuing value-based managed care contracts with their payers. Others are still predominately in fee-for-service contracts and taking a slower approach toward value-based contracting. Even organizations in a wait-and-see mode realize value-based care is the right thing for the community and that it will create sustainability around healthcare as a whole. However, many are still evaluating the risks associated with this transition and the cultural change that will need to happen among physicians.
2. Incentivizing physicians is key
Recent research by The American Academy of Family Physicians shows that incentives are critical in driving change in physician behavior. Physicians are anxious to be rewarded for the value of care they are delivering, which is why organizations are aggressively changing their reimbursement strategies. Some of these changes are as simple and non-traditional as paying physicians more for staying open later in the week and emailing with their patients. But, it’s more than just incentivizing physicians, it’s supporting their efforts to take patients through the continuum of care, rather than individual episodes of care. In this model, both the patient and physician benefit.
3. Transparent data drives improved quality of care at lower costs
The use of technology, people and process is key when moving in the direction of value-based care. Consumers not only want full transparency when it comes to their personal medical records, but they also want insight into their physician’s performance. Physicians are now empowered to use data, rather than relationship history, when referring their patients to sites for service and fellow medical professionals. Data-driven recommendations result in better patient outcomes at lower costs. And, when data is available to measure performance, it enables physicians to make better decisions on behalf of their patients and improve care delivery.
Healthcare is an ever-changing environment. Successful organizations are those taking the time to increase quality, lower costs, and ensure patient and physician satisfaction is achieved. It will take time to get all the right answers, but it’s encouraging to see so much innovation happening in support of value-based care.
To learn more about what Nashville’s healthcare leaders had to say, view the entire panel discussion here.
