Focus on population health helped Baycare leap to value
Photo: Jeff Lagasse/Health Financing News
ORLANDO, Fla. – Value-based care will continue to accelerate, and the best path forward for healthcare systems, both from a financial and clinical quality perspective, is to have a clear and a strong population health framework.
That was the message conveyed by Dr. Nishant Anand, Executive Vice President and Chief Medical Officer of Baycare Health System, at HIMSS22 in Orlando. Anand has helped Baycare enter the values-based world, with positive results.
Speaking at his session, “Preparing your healthcare system for a successful journey to value,” Anand said Baycare’s value-based journey has been successful largely through the use of models evolving payment models that have enabled the healthcare system to use value-based contracts towards a better population health model – a model that is also driven by data, analytics, patient engagement and providers and coordination of care.
The benefits of this are tangible, he said.
A case in point is Florida, which has seen at least five outbreaks of the COVID-19 virus. Every time a wave hit, paying entities suffered, while value-based organizations saw their margins increase.
While an organization shouldn’t move too quickly in the value-based world — because that has the potential to disrupt profit margins — the journey has to happen, he said. According to Anand, the Centers for Medicare and Medicaid Innovation believe the program needs to drop in value by 2030 due to solvency issues.
One of the first steps for a healthcare organization is to decide which market segments to focus on. Anand suggests targeting traditional Medicare, Medicare Advantage, Medicaid, and self-paid patients.
Three competencies must be defined to succeed in these efforts: value-based contracting, building population health service organizations that take advantage of economies of scale, and networks.
All are important, but population health service organizations can centralize a system’s capabilities, Anand said, while networks can benefit from the presence and contribution of experienced clinicians.
“We focus a lot on engagement,” he said. “If people aren’t engaged, they won’t respond to what you do. We always have this trend in healthcare: if your network is too big, you want to shrink it. If it’s too small, you want to Consider putting your most advanced doctors in the inner circle.And you need some people for network adequacy.
Baycare’s population health model emphasizes community resources such as Feeding Tampa Bay, which addresses the social determinant of food insecurity, thereby addressing a potential pathway for worsening health. The model also focuses on risk adjustments, and the system launched a Medicare Advantage plan in 2019 that is ranked in the top 5% nationwide, Anand said.
But one system can’t do it all at once, he advised.
“We are looking for quality,” he said. “We have pathways for colorectal screening, for mammography. We focus on risk adjustment coding. It is imperative to do proper coding when working with people on Medicare Advantage or individual exchange. We we also focus on end-of-life and palliative care – if you can make the transition smooth people will be very grateful.
“You can see value-based care is there,” Anand said. “It may seem slow, but the trajectory is there.”