Hope Plavin, MPA, is the Director of the New York State Department of Health Innovation Center. The center is devoted to using government finance and policy levers to transform health care for New Yorkers by improving quality and access while also reducing cost. Plavin recently spoke with CAMH about her organization’s commitment to value-based payment.
In New York (NY), better health outcomes and value are a top priority. In December 2014, we received a $100 million State Innovation Model (SIM) testing grant from the CMS Innovation Center. The purpose was to implement our State Health Innovation Plan (SHIP) and transform primary care over the next four years.
An integrated care work group of multiple stakeholders is developing an advanced primary care model for NY. A key part of the model is value-based payments. We’re discussing with stakeholders throughout the state the pros, cons, and tradeoffs of different payment approaches to reach our goals. We’re focused also on expanding the primary care workforce, integrating clinical and population health, and developing a common scorecard, metrics, and analytics.
As part of our testing grant from CMS, we’ve proposed that we not only change the care delivery model to provide incentives for team-based care in the primary care setting but also that we change the reimbursement model to pay for the team care approach and to evolve to “pay for outcomes.” Although this may look different from one payer to the next, we want all payers in the state to align. The question is, what is the level of individuality versus the level of shared alignment across multiple public and private payers statewide so that incentives for each primary care practice are consistent? For a practice with patients covered by five health plans, for example, how do we ensure those plans’ payment schemes and quality measures are aligned enough so that the practice can focus on specific goals and outcomes and can be reimbursed for team-based care?
Many commercial payers are using these models already. We want to make sure we’re supportive and don’t get in the way of their progress. Yet we need to achieve the desired degree of alignment across practices to make this model work.
Along with the alignment challenge, we face proprietary concerns. Many large health plans have developed their own primary care delivery and payment models and are succeeding. The details of exactly what they’re doing by practice size and location are not being shared. The question we’re trying to address is, what is the right degree of alignment to reach our goal, yet still give each payer enough flexibility to carry and sell its individual product?
For us, innovation means thinking broadly about how to structure care delivery and payment systems to bring the best possible outcomes for all. It means going beyond the Triple Aim to look at the Triple Win. How do we keep people healthy, keep prices down, and keep the right set of providers engaged and supported at the right level? It means understanding that the practice of health care is rapidly changing. Much of the care once provided in a hospital is now being delivered in an outpatient setting, from urgent care centers to doctors’ offices in our local supermarkets. These are new delivery models that consumers are liking and using. How do we make sure these models are integrated as part of the care continuum so that wherever patients are served, the result is better health outcomes?
We were excited that the LAN and NY have the same vision for the future of health care. We want to work with our colleagues throughout the nation to make transformation a reality and create a critical mass in learning, implementing, and evaluating new approaches to health care payment and delivery.
Providers and payers often ask us why should we implement APMs? What’s in it for us? The LAN draft White Paper released October 22, 2015 included a summary of findings to date that was hugely helpful to us. We encourage the LAN to continue on that path of amassing the evidence that will show why these are reasonable models and what benefits they will bring. For example, if you’re a provider implementing an APM, you can see fewer patients a day, spend more time with each patient because you’re part of a broader care team, and be paid more because you’re sharing savings by keeping patients healthy. If you’re a payer in an APM, you can lower your costs, raise your margins, and increase your likelihood of member retention. Keep digging down into the “why.” Help stakeholders understand their return on investment in reworking business strategies and becoming part of the solution.