In breakout discussion groups, attendees were asked to offer input on key issues to address when developing value-based partnerships.
Here are four vital questions and the respective attendee answers.
What do health plans, hospitals, physicians, and employers collectively need to do to form a successful value-based relationship?
- Understand the goals and vision of each entity at the start of discussions.
- Learn about the culture of each organization when coming together. No one organization can have authority over other entities in the relationship; the relationship must be collaborative.
- Establish common goals for care coordination and efficiency of care to achieve quality.
- Establish trust and transparency with all stakeholders.
- Share common data.
- Remain open-minded, but agree to disagree.
- Redefine roles up front; traditional roles should shift. Communicate often and effectively. Dedicated resources will be needed to ensure that communications between stakeholders are timely.
- Offer education for all parties to help structure the new culture of collaboration. Define the infrastructure and dedicated resources from both a provider and a health plan perspective. A medical group and chief medical officer should be part of conversation.
- Plan and structure the relationship using shared accountability.
What obstacles could potentially impede success?
- Built-in silos within organizations
- Inconsistent communication
- Governance limitations or technical challenges in sharing information
- Poorly defined strategy or plan design (resulting in a lack of focus on the patient)
- Lack of technology (or an inability to utilize it effectively)
- Lack of engagement among partners (are the right people at the table?)
- Ineffective care management
- Financial challenges (given that “the pie is not getting any bigger” and getting additional cost out of the system may be a formidable challenge)
- Potential risks to previous capital investments
- Regulatory, regional, state, and national uncertainty related to the impact of the Affordable Care Act, the Medicare Access and CHIP Reauthorization Act (MACRA), etc.
- Cultural issues in implementing changes to move to value
- Cost pressures, particularly for small community hospitals
- Clinical variation
- Narrow-network characteristics that may create access issues and perception problems for employers
What characteristics or capabilities are necessary for success?
- Data: integrity, timeliness, ability to interpret and use
- Acceptance of data
- Transparency. Early wins to build trust and momentum
- Champions/leaders to drive the effort
- A patient-centered approach by all stakeholders
What are the limiting factors that each partner must overcome within its organization to build success in a value-based partnership?
- Fear of change among organizations and people
- Difficulty with the sharing and integration of data
- Not having a defined set of quality metrics
- Lack of access to an adequate volume of live data as opposed to claims data
- A short-term focus as opposed to a long-term strategic perspective
- Limited workforce supply (are there enough physicians?)