Gabriel Perna | August 18, 2021
Throughout every corner of the health care system, COVID-19 has ushered in a new era of collaboration and partnerships. Stakeholders have set aside competitive differences to leverage each other’s resources to ensure patients, COVID or otherwise, are being treated as effectively and efficiently as possible in this crisis.
“We found that when there’s a stark emergency like COVID, hospitals are willing to come together and collaborate. They really just appreciate taking the time to get together on the phone and listen to what everyone else is experiencing,” says Kate Schellinger, Interim Executive Director of the Illinois Medical District. “I think the fact they all had shared goals really helped them come together and collaborate, rather than be competitors.”
During the height of the COVID pandemic, both in March and April of 2020 and later during the second surge in the winter of 2020-21, the Illinois Medical District, a unit of local government whose membership includes major health care providers and organizations within and around Chicago, convened these stakeholders in twice-weekly calls to discuss the challenges they were all facing. The shared goals that Schellinger was referring to were pretty simple: “They wanted to prevent severe illness and death.”
That kind of goal is pretty straightforward, even if it can be difficult to achieve.
But can health care organizations continue the collaboration momentum in achieving a different kind of shared goal—perhaps the largest shift, rivaled only by digital transformation, the industry is currently facing other than pandemic response—moving the health care system to value-based models of care?
Partnering to address a fragmented and siloed system
The impetus for value-based care partnerships may not be as sudden and immediate as preventing COVID-related illnesses, but it’s incredibly important in changing the industry paradigm.
The transition to value-based care, in fact, was well underway in various stages long before COVID-19 and, if anything, the pandemic has demonstrated weaknesses in traditional fee for service payment models dependant on patient volumes that have highlighted the potential of alternative care models.
“Very little care is delivered in a hospital and the emergency department. An even smaller amount is delivered in academic medical centers. It’s an expensive part of the care delivery system, but it’s small part of where people actually get their care. By working together, we can change that paradigm of expensive care,” says James Dom Dera, MD, Family Medicine Physician and Patient-Centered Medical Home Medical Director for NewHealth Collaborative, Summa Health during a recent American Hospital Association webinar. “Right now, the system is fragmented and siloed. We’re paying for episodes of care. What we need to do is partner and work together in a value-based arrangement.”
Partnerships key to effective value-based models
Collaboration in value-based care doesn’t have to overly complicated, says Dom Dera. Reducing ED visits and length of stay often comes down to a health system working directly with a patient’s primary care provider or a care navigator. In some cases, he says that connecting patients with primary care providers can reduce readmissions by 25 percent.
In an effective value-based model, there are also multiple touchpoints for patients, with technology platforms and specialty care providers, rather than relying on a handful of in-person visits throughout the year. Summa Health relies on some of these resources from its ACO, NewHealth Collaborative, to provide many of these services for its patients. In return, the ACO gets improved outcomes and lower costs.
“When it’s done well, the ACO is a powerful tool and it’s done well by working together,” said Dom Dera. “Primary care is being disrupted by companies with ACO approaches and they are being funded by venture capitalists, private equity, health plans and in some cases, health systems. They are funding these larger ACO approaches where everyone works together to drive value.”
Quil Health CEO Carina Edwards is a big advocate for the power of collaboration when it comes to health care’s shift towards value. The company she leads, which offers a consumer engagement platform for payers and providers in population health arrangements, was the brainchild of a collaboration between NBC/Comcast and Independence Blue Cross.
The company has partnered with Penn Medicine to reduce readmissions, length of stay and increase discharge rates to the home rather than skilled nursing facilities. Success in these arrangements comes down to leveraging the strengths of the various entities involved, says Edwards.
Carina Edwards, Quil Health
“The beauty is access. I collaborate with the business intelligence and the data scientist teams at Independence Blue Cross. I collaborate with the R&D teams at Comcast and NBC Universal. We get access to some of the most engaging entertainment capabilities and that makes it work,” Edwards says.
She adds that various partners must ensure everything is integrated into the workflow, which is vital to collaboration.
“EHRs and foundational portals aren’t going anywhere. I believe in information sharing and integrating consumer data into the Epics and Cerners of the world so the providers, case managers have eyes on their patient population. It’s critical. You have to integrate into the fabric of health care to make an impact,” Edwards says.
Addressing the social determinants of health is another necessary area of collaboration between disparate partners in value-based arrangements, says Anna Spencer, Senior Program Officer, Center for Health Care Strategies. Spencer says that health plans and payers are increasingly partnering with non-profit community organizations to address these challenges.
“There is a growing recognition that to improve population health, it’s just as much about improving those social needs as it is delivering high quality care. This is particularly true for populations with complex medical and social conditions. There is an increasing body of evidence that says addressing the social determinants of health results in cost savings,” Spencer said during the AHA webinar.
What other CEOs can learn from existing partnerships
Partnerships to advance access, affordability and value-based arrangements, like almost any other kind of deal, must be built on a foundational value proposition that appeals to, at the very least, health systems, health plans and community-based organizations.
Whether for COVID-19 response or looking ahead to value-based care models, such shared-goal partnerships will require executives to consider multiple elements in addition to that value-proposition: the unique needs of third-party community-based organizations, buy-in at the highest levels and overall change management.
Spencer says a strong value proposition will help various parties become willing to put in the work to achieve those shared goals. For community-based organizations are brought into a value-based arrangement, this includes creating a system of governance that benefits all parties, figuring out a sustainable model of funding, and the ubiquitous challenge of integrating all these social services into the workflow.
Edwards at Quil Health agrees with this concept and adds that getting institutional buy-in is going to be a significant challenge for anyone on this journey to value-based care.
“Change management, especially at large institutions, is always a challenge. As you’re bringing new things to bear, how do you make it uniquely theirs and how do you partner with all aspects of the organization? The world we live in is all about engaging that front door and that digital individual experience. It’s everything from the front desk staff to the doctor, to the nurse to the physical therapist to the marketing department, to the COO of the business line. You have to think about your value proposition, where you fit and how you support the business goals of that organization,” Edwards says.