INDIVIDUAL COMMITMENT STATEMENTS
The below organizations have not only signed on to the Shared Commitment Statement for the LAN’s Healthcare Resiliency Collaborative, but have gone a step further by committing to specific actions that will help their organization achieve resiliency in the healthcare system. Hover over each organization to see what steps they are taking.
Ballad Health is fully committed to building a more resilient, equitable and accountable health care system. Twenty-five to thirty percent of health care is considered wasteful, and personal health is driven largely by social determinants and social needs. We can only improve the health of our communities, and diminish the disparities which continue to plague them, by unlocking this waste and redirecting it towards better care management, elimination of low value care, and improved access to integrated primary care, behavioral health services and social supports.
Ballad has successfully embraced CMS APMs such as the Medicare Shared Savings and Bundled Payment programs, as well as CMS efforts to meet health related social needs through our Accountable Health Community grant. We believe the actions outlined in the HCP-LAN resiliency framework not only align with these and other Ballad Health efforts but provide a clear guide for further action.
We commend CMS for its efforts to address rural community health and health care resiliency through new APM authorities. We further encourage CMS, and national commercial payors, to embrace total cost of care approaches and to continue to reduce complexity, increase predictability, and provide the flexibility necessary for rural hospital systems to meet the health care and related social needs of rural communities when, where and how patients need it. These approaches may look much different than the payment and delivery systems of today.
At Blue Cross and Blue Shield of Minnesota, effective APMs are core to our strategic plan of transforming and reinventing the health care system. Prior to COVID, we had forged Category 4 LAN arrangements with two major systems and a leading specialty group in our market. The onset of the pandemic only accelerated this approach. In short order, we provided cash-flow relief to ACOs on route to APMs; announced an APM partnership with the state’s largest care system and a network of 47 independent practices; and have begun to build APMs with a coalition of rural hospitals. Wellness and Health Equity are growing priorities for all of our APMs, with a sharpened focus on metrics, transparency and programmatic investments that can address racial and health disparities throughout Minnesota.
Actively advocate, influence and hold accountable partners, intermediaries and other stakeholders that they support the items outlined within the framework.
Our organization is committed to a healthcare system that is responsive and resilient to events such as the unprecedented COVID-19 public health emergency and achieves improved patient experiences and outcomes, reduced disparities, and greater affordability and accessibility in the recovery from the crisis – not just a return to previous models of care and payment. In collaboration with other payers, providers, employers, and patient/consumer groups, we will lead the way through actions that help accelerate our transition to effective APMs, including those that incorporate population-based payments. In doing so, we commit to focusing on four areas (among others):
- Complete the transition of Intermountain Medical Group practitioners’ payment mechanisms to bases that are supportive of prepaid care (as opposed to fee for service).
- Provide an optimal mix of telehealth vs. in person visits. For primary care, we will maintain telehealth and home visits at a level of at least 40% of total visits in 2022.
- Expand the availability of Artificial Intelligence bots in its digital app for patients to allow expanded self-care for at least 10 common diagnoses.
- Use artificial Intelligence to identify and stratify chronic kidney disease patients to reduce the need for dialysis, increase timely transplantation and allow at least 60% of dialysis to take place at home.
PFCCpartners has a vision to reinvent the healthcare system through partnership among stakeholders of health, including patients and family caregivers.
PFCCpartners is committed to connecting the perspectives and voices of the PFAnetwork. The PFAnetwork consists of 620 patient and family caregivers using their lived experience to inform health care transformation through collaboration on project teams, research teams, health system advisory councils, quality improvement projects and policy efforts, to inform the work of the Resiliency Collaborative. The PFAnetwork is a remarkably diverse community, representing rural and urban care, socio economically challenged communities and is ethnically representative. Additionally, the community represents Medicare beneficiaries, private and employer sponsored health plans and Medicaid program participants receiving care for chronic conditions and typical care. Through PFCCpartners, the Resiliency Collaborative will have access to the direct lived experiences of this diverse community as we begin to evaluate the impacts and effects of the pandemic on communities across the country. We recognize the critical insights and information patients have about how the public health emergency has been experienced. PFCCpartners will support the aims of the collaborative to create healthier communities through payment models that promote high quality, equitable outcomes for all Americans.
Cigna is committed to creating a health care experience for our customers that is affordable, predictable, and simple. Our success in delivering on our mission and strategy is closely tied to the partnerships we have with our health care providers. Our commitment to value- based care is evidenced by the breadth and depth of value-based relationships that we have forged with providers across all of our lines of business and in all categories of alternate payment models (APMs). Over the past several months, the COVID-19 global public health emergency has highlighted areas of opportunity where we can further support health care providers: Helping them care for their patients, rewarding them for delivering improved health care quality, outcomes, and affordability, and providing them with greater financial stability than what fee-for-service alone can deliver, in their respective practices. Additionally, the pandemic has heightened the need for enhanced focus on the disparate health outcomes that some populations experience and on social drivers of adverse health outcomes.
Cigna agrees to the “Shared Commitment Statement” as proposed by the HCP-LAN Healthcare Resiliency Collaborative. As evidence of our commitment, Cigna will:
- Incorporate health disparity reduction measures in all of our APM models by 2022
- Continue to promote the use of and provide adequate payment for telehealth as a channel of care delivery
- Continue and expand on our existing capabilities that enable health care providers to conduct virtual peer-to-peer “e-consults”
- Continue to expand the use of depression screening across all APMs to address behavioral health issues
- Thoughtfully expand the penetration of prospective, population-based APMs.
- Enhance our existing APM models to reflect the unique needs of the public health emergency, thereby ensuring that the most vulnerable populations receive the care that they need and that health care providers are supported during this time of financial uncertainty
We at Cigna applaud the work of the HCP-LAN and are proud to be a partner in its endeavors to improve health care resiliency. The global public health emergency has accentuated key areas of opportunity in how we serve our customers and patients, and we are committed to addressing these. This is fundamental to our mission to improve the health, well-being, and peace of mind of the people we serve.
The Washington State Health Care Authority (HCA) purchases care for Washington State Apple Health (Medicaid) and public and school employees and retirees, covering over 2.5 million people. Our value-based purchasing (VBP) goals span across all state-purchased health care and we aim to tie 90 percent of state-financed health care payments to quality and value by the end of 2021, defined by payments in Health Care Payment Learning and Action Network (HCP-LAN) categories 2C and above. As of 2018, HCA has exceeded the initial 2020 HCP-LAN target of 15 percent for payments tied to quality and value through two-sided risk arrangements, both for Apple Health (17 percent) and employee benefit programs (25 percent). COVID has accelerated the need for non-visit-based payment methodologies that are tied to value and result in improved health of our population.
HCA will advance models that can best support providers and health plans recovering from the pandemic, including the rapid adoption of virtual care. We are committing to further our VBP reach by redefining our VBP goals through 2025 with a focus on cross-program alignment, data-driven policy making, and multi-payer models. We will sustain successful initiatives and test new programs to continually drive the health care system toward improved outcomes, patient and provider experience, and equity while containing costs. A key opportunity to expand our VBP efforts is a multi-payer primary care payment model that has:
- Primary care as integrated whole-person care, including behavioral and preventive services. We have moved to integrated behavioral health and physical health provided in our Medicaid managed care plans statewide and are working on improving the behavioral health services in our public and school employee benefits.
- Shared understanding of care coordination and providers in that continuum.
- Plans will align payment approaches, which will be tied to measurable value metrics and may include a combination of transformation of care fees, comprehensive payments, and performance-based incentive payments. More specifically the model will provide a prospective incentive payment on a quarterly basis to drive performance improvement.
- Payers agree to an incremental and defined percent of spend on primary care as a proportion of total cost of care.
- Patients are empaneled or attributed to high-functioning care teams to coordinate and provide care, and patients receive meaningful annual engagement using a range of modalities.
- Application of actionable analytics (clinical, financial, and social supports).
- Payers agree to use a core set of outcome measures of increased quality of care, improved health for patients, and reduced cost, and process measures that reflect progress toward those care transformation goals.
Our second commitment focuses on health equity. The myriad events of 2020 have reinforced the necessity of leveraging health care purchasing to address health inequities and HCA strives to eliminate inequities through our health care programs and partnerships. We have realized our race/ethnicity data is captured inconsistently and has gaps. Our focus is on data collection and stratification of quality measures by race/ethnicity and this work will lay a solid foundation for our health equity efforts going forward. To be specific, by July 2021 we will:
- Develop a plan to stratify quality metrics by race and ethnicity in managed care and Washington’s public option (Cascade care) health plan.
- Expand the collection of race, ethnicity, and language data in the public and school employee benefits programs.
- Standardize select questions on social determinants of health for Managed Care Organizations initial health assessments for clients with special health care needs.
- In collaboration with the Washington Office of Broadband and the University of Washington Behavioral Health Institute, we are working to expand technology supports to more communities.
HCA is delighted to join other payers and organizations in signing onto this reviewed commitment by the HCP-LAN and look forward to continued progress in improving health care.
Geisinger Health is committed to evolving our healthcare system to one that achieves better health and lowers total cost of care. We believe our approach will be resilient, sustainable and more responsive and resilient to events such as the COVID-19 public health emergency. We believe that Population-based payment, along with complementary advancements in care delivery, is a critical mechanism to achieve our goal.
As an integrated system, Geisinger has a number of advanced payment models already in place, including operating our own health plan, and has developed a number of innovative care delivery models that have allowed us to focus on total health rather than the volume of services rendered, consistent with the goals intended by the LAN Category 4 arrangements. Such models include:
- Geisinger at Home: a home-based care model for the sickest 3% of the patient population (the majority of whom are in Medicare Advantage). We are already seeing significant improvements in patient experience and outcomes along with net savings for this program, despite the relatively high touch, high cost approach.
- Medication Assisted Treatment (MAT) clinics: as part of our response to the opioid crisis, we have launched our own MAT clinics that are fully coordinated within our broader clinical enterprise including behavioral health, enhancing access and promoting superior integration of care.
- Senior-Focused Primary Care: this primary care model offers enhanced care coordination, care management, wellness and social activities, as well as longer than usual visits, to create a concierge experience for Medicare Advantage members selecting these clinics. We have seen ER and inpatient hospital utilization rates decrease significantly and result in an overall decrease in total cost of care for these populations.
Our experience during COVID-19 is that these models have not “skipped a beat”: the financial base is stable, and the care has been there when patients needed it the most, mostly outside of the institutional environments including in their own homes.
Geisinger is also committed to supporting rural health through payment reform. Geisinger Jersey Shore Hospital participates in the Pennsylvania Rural Health Model with CMS and other state and local partners, under which it is paid a multi-payer-global budget as a way of stabilizing revenue and allowing transforming services in rural communities to better fit the needs of the communities.
Our perspective on the shift to APMs is that just setting targets is not enough. In order to be successful the APM’s must be thoughtfully designed to align payment and care delivery, both working together towards specific quality and cost goals. For this reason, Geisinger commits to continuing to build on programs and approaches as described earlier, and by doing so, promoting resiliency through sustainable payment reform as the US recovers from the effect of COVID-19.
The Council of Medical Specialty Societies (CMSS) supports a resilient healthcare payment system that ensures all patients are able to receive the highest quality of care possible and that physicians and other clinicians are fully supported in providing that care. We strongly support greater focus on disparities, inequities and social determinants of health in our payment and delivery system. We commit to working with payers and purchasers to devise APM models that support the goal of high-quality, equitable care for the patients we serve.
GuideWell is committed to establishing mutually beneficial relationships with physicians and health systems that include financial incentives to develop initiatives that help people and communities achieve better health and provide affordable coverage.
In 2020, this pursuit became more important as the COVID-19 public health emergency has dramatically affected the health care delivery system and our members. As a health solutions enterprise, we are unwavering in our commitment to advance our APM portfolio, and we will continue to focus on partnerships and models that address the affordability crisis our members face, expand access to value-based care for our members, focus on outcomes, and improve our members’ experience.
GuideWell’s efforts focus on initiatives that address health care inequities and mental well-being across Florida, and the incorporation of behavioral health and innovation – including telemedicine – are critical components of our APM go-forward strategy.
We will continue to create and fortify partnerships that build upon shared success from the past while stabilizing the present and aligning collective focus on long-term affordability and accessibility.
Blue Cross and Blue Shield of North Carolina (Blue Cross NC) Action Items Supporting the Shared Commitment Statement:
Since the start of the COVID-19 pandemic, Blue Cross NC has supported providers through a variety of measures, including:
- Expanding virtual care by paying providers the same for visits by video or phone that we pay for in-office visits. This includes all specialties and all services that can be delivered through telehealth, regardless of whether it may be related to COVID-19.
- Removing administrative tasks to improve access to care.
- Enhancing Blue Cross NC’s claims payment processes to speed payments, resulting in 90 percent of completed claims being paid within 14 days.
- Reinforcing the health care workforce by speeding credentialing.
Blue Cross NC is committed to continually evaluating the needs of our providers based on the current state of the pandemic and adjusting our support measures to meet those needs.
Additionally, independent primary care practices are the foundation of our health care system. These practices are instrumental in improving outcomes, quality and patient experience. Unfortunately, the effects of the COVID-19 pandemic have created a financial crisis for independent primary care practices. This is on top of the undervaluing of primary care that existed in our health system before COVID-19.
Because of this, Blue Cross NC launched a two-year program in June to provide financial support to independent primary care practices while also helping them move toward value-based care. The program is called Accelerate to Value.
Practices in the Accelerate to Value program receive supplemental payments to stabilize their Blue Cross NC revenue at their pre-COVID-19 level. The hope is that these payments will enable these practices to continue serving their patients and ensure access to high quality clinical care for Blue Cross NC members during the COVID-19 pandemic.
Payments to participating providers started in August 2020 and will continue through 2021 for all participating practices that meet the program requirements described below:
- Practices must commit to providing access to care for Blue Cross NC members. This means pledging to remain open, promote the use of telehealth and provide care coordination and care delivery activities responsive to the COVID-19 pandemic.
- Practices must move toward shared accountability for total cost of care by joining a Blue Premier accountable care organization (ACO) by Dec. 31, 2020. Blue Premier, the company’s value-based care program, allows primary care providers to earn shared savings payments by reducing the total cost of care and improving quality of care for the patients they serve.
- In 2022, Blue Cross NC also will offer a model for primary care provider (PCP) capitation to practices in the Accelerate to Value program. PCP capitation will let practices determine the best way to deliver primary care to all of the patients they serve, allowing for new flexibility in how and when that care is delivered.
COVID-19 has exposed the profound vulnerability in the health and viability of our health care system that depends on a traditional fee-for-service payment method. That’s why we included a path to Blue Premier within Accelerate to Value.
Blue Premier differs from most other value-based programs because it requires shared financial risk. If providers meet agreed-upon goals for quality and cost, they stand to gain through performance payments. If they don’t, they may face penalties paid back to Blue Cross NC.
Throughout last year we worked with five of the largest health systems in North Carolina and four primary care ACOs to establish the program, share data and check our progress. What we did in year one has laid the groundwork for future years of Blue Premier, including moving providers to shared risk in year three and beyond.
This staged approach to shared risk allows us to calibrate our program to the current environment and the needs of providers. We are encouraged by this approach thus far, not only because of the results from our original Blue Premier cohort, but also because three additional health systems and dozens of primary care practices have joined Blue Premier since the program’s launch in January 2019.
Caravan Health is committed to improving health care outcomes and strengthening rural care through the power of value-based payment. Since 2014, Caravan Health has introduced value-based payment to rural communities with outstanding care quality and financial results achieved by focusing on nurse-led population health management and building scale to mitigate the statistical noise that can distort performance. Our team-based system of integrated primary and specialty care is essential preparation for an unexpected public health emergency that requires a quick and robust response. Forward-thinking approaches to care, such as permanent telehealth and virtual options, will help achieve a sustainable future that is safe for patients and providers alike. Scaling alternative payment models based on the financial and technological needs of providers, patient populations, and multiple payers will lead to a responsive, resilient, and data-driven rural health system. We will continue to bring value-based payment innovation to rural communities, and pledge to add 100,000 new rural patients into risk-bearing alternative payment models in the coming years.
Our organization is committed to a healthcare system that is responsive and resilient to events such as the unprecedented COVID-19 public health emergency. Our objective is to improve patient experiences and outcomes, reduce disparities, and provide greater affordability and accessibility in the recovery from the crisis – not just a return to previous models of care and payment. In collaboration with other payers, providers, employers, and patient/consumer groups, we will lead the way through actions that help accelerate our transition to effective APMs, including those that incorporate prospective, population-based payments. In doing so, we will prioritize three resiliency areas:
- Promoting equity in healthcare through intentional APM design and implementation, emphasizing measurement, adequacy in payment, and evidence-based social determinants of health and other interventions;
- Calibrating APMs to account for varying needs for capital and other non-financial support across different types of providers reflecting their resource needs, capacity, and variation in local and community needs;
- Advancing whole-person, person-centered care through increased clinical integration of primary, specialty, and other care, with a particular emphasis on behavioral health, utilizing virtual care and other novel care delivery modalities
Prisma Health is committed to moving along the path to Category 4 payment models. We presently have 320,000 lives at significant downside risk but no pure premium or PMPM risk models. We have been very successful in our downside risk models due to our engaged network of 4700 providers coupled with our robust clinical data and analytics resources as well as our extensive care management teams and our Accountable Communities program. Although we were performing virtual visits prior to COVID the pandemic pressured us to increase this to over 5000 visits per day.
As we have seen, the pandemic demonstrated that the U.S. public health infrastructure was significantly under-resourced and poorly engineered to accommodate such a national disaster. Our competencies and infrastructure related to our population health strategy that allowed us to be successful with our at-risk contracts also allowed us to identify patients at a community level who had COVID and mobilize resources to intervene.
Luckily the competencies and resources we had developed within our data systems and Accountable Communities programs allowed us to mobilize our community resources and community partnerships informed by our data to identify areas of increased COVID-19 infection rates coupled with racial and economic disparities. We found that in addition to racial disparities (African American and Hispanic) that income levels of less than $20,000 per year predicted a dramatically increased mortality rate. These were some of the same analytics we were using to identify disparities in our at-risk populations.
The very competencies we created to manage populations at risk prior to COVID-19 turned out to also be the very same competencies that made us more successful managing a pandemic. As we move forward, we need to continue to enhance these competencies and move to more risk and efficiency.
CVS Health supports the Health Care Payment Learning and Action Network’s health care resiliency collaborative. The pandemic has highlighted the need to continue the movement toward advanced payment models that create greater financial stability for providers and support better outcomes and value for patients. Our near-term actions are reflective of our broader, long-term strategy, which puts the individual and the clinical and non-clinical services they need to advance their health and wellness and make healthcare more affordable at the center of our provider network design.
We have taken action to support providers financially during this time as well as support care delivery, including:
- adjusting quality measures and scoring to account for impacts of not being able to see patients;
- helping with timely payment of performance bonuses earned; and
- enacting payment parity for telehealth services in most cases, while also rapidly expanding payment policy to support broader applications of telehealth.
We endeavor to create a true partnership with providers that both aligns the incentives for high quality and whole person care, as well as provides support services that can assist them in achieving better outcomes. This will include efforts to:
- refine our approach to APMs to address the unique capabilities of different provider types and organizing models (systems, practices, etc.);
- accelerate movement towards alternate financial models that provide opportunities for more predictable and consistent revenue;
- continue to advance payment policy to expand the use of telehealth and the impact of various virtual health strategies within targeted clinical delivery models;
- expand our efforts to support providers with data and intelligence that assists them in proactively addressing patient’s unique health and social risks and needs, such as by building upon our long-standing efforts of utilizing voluntarily provided member data on racial and ethnic equity as one way of improving quality of care;
- utilize the broader assets of CVS Health to support providers with clinical services that help them fully meet patient needs for screening, education and social supports and complementary care; and
- continue to expand access to and integration of behavioral health support into advanced primary care and payment models.
North Carolina Department of Health and Human Services (NC DHHS) shares in the vision of the Healthcare Resiliency Collaborative’s core commitments to build a healthcare system with smarter spending that incentivizes improved health,
- Enhanced overall payment rates, including increased per member per month payments to primary care medical home practices, with additional targeted payment rate increases for FQHCs and Rural Health Clinics;
- Retainer payments for providers of home and community-based services;
- Expanded coverage and reimbursement of telehealth and virtual visit services;
- Comprehensive social and health support services for individuals in isolation or quarantine.
As NC DHHS continues to respond to the ongoing public health emergency, the Department wants to support a culture of shared accountability for health with the upcoming initiatives:
- Continued opportunity for Medicaid providers to participate in the Department’s Advanced Medical Home model program which provides funding infrastructure and comprehensive data to help primary care practices take on higher levels of responsibility for cost and care outcomes. Creating new opportunities for primary care providers to align with state models for taking on higher levels of APMs, including Population-Based payments. Continued emphasis on innovative care delivery models by maintaining most of the expanded telehealth flexibilities.
- Continued emphasis on using quality measurement and improvement, in alignment with industry standards, to promote health equity by collecting, analyzing, and transparently displaying differences in quality rates among groups and setting aggressive targets for closing those gaps.
- Healthy Opportunities Pilots focused on addressing non-medical drivers of health by delivering integrated health and social care for individuals in four domains: food security, housing stability, transportation access, interpersonal safety.
- Transitioning NC’s Medicaid program from fee-for-service to managed care with focus on whole person care, integrating physical and behavioral health as well as non-medical drivers of health and using this opportunity to intentionally and boldly drive health equity though program design.
- Updating NC Medicaid’s clinical policies, quality initiatives and provider payment approaches to better reflect the unique needs of populations with complex medical conditions and disproportionately less access to resources, including historically marginalized populations.
- Establishing ambitious VBP targets tied to the HCP-LAN Framework and increasing to higher levels over time, with emphasis on addressing health disparities.
The Department’s focus on “buying health” and not just health care is essential to building a sustainable, high-quality Medicaid program in North Carolina. NC DHHS would like to thank the HCP LAN for the opportunity to pledge support for the Resiliency Collaborative’s statement.
For more than a decade, Blue Cross Blue Shield of Massachusetts (BCBSMA) has engaged in value-based partnerships with provider groups via the Alternative Quality Contract (AQC), a population-based payment model that has successfully improved quality and slowed the growth of health care costs. In 2020, BCBSMA has expanded this value-based payment framework to smaller provider organizations, rolled out a new partial capitation model for primary care practices (to replace fee-for-service completely for primary care), and initiated enhanced payment for behavioral health integration in primary care.
BCBSMA’s partial capitation model will offer considerable flexibility to primary care practices, which will be able to provide care using the visit modes (e.g., telehealth) and resources (e.g., health coaches, social workers, etc.) that would benefit their patients most. These APMs also will help provide a reliable revenue stream for practices even in the event of disruptions in care, such as the drop in office visits during the COVID-19 pandemic. The three elements of the program—a patient-based payment model, robust incentives for efficiency and quality performance, as well as an immediate support payment for practices that sign on—offer a compelling response to the impact of COVID-19 on independent primary care. As part of these APMs, BCBSMA will continue to share data and analytic tools, and provide additional support to participating providers.
These new models represent the latest steps in a long-running commitment by BCBSMA to invest in primary care practitioners, including those in small, independent medical practices. The importance of expanding value-based care to smaller provider organizations is underscored by the pressures of the current COVID-19 pandemic.
Our organization is committed to a healthcare system that is responsive and resilient to events such as the unprecedented COVID-19 public health emergency and to a healthcare system that achieves improved patient experiences and outcomes, reduced disparities, and greater affordability and accessibility in the recovery from the crisis – not just a return to previous models of care and payment.
In collaboration with other payers, providers, employers, and patient/consumer groups, we will lead the way through actions that help accelerate the transition to effective APMs, including those that incorporate prospective, population-based payments.
In doing so, we will prioritize three resiliency areas:
- Promoting equity in healthcare through intentionality in APM design and implementation that emphasizes measurement, adequacy in payment, and evidence-based social determinants of health and other interventions
- Calibrating APMs to account for varying needs for capital and other non-financial supports among differing types of providers with differing levels of resources and capacity, and to differing local and community needs
- Advancing whole-person, person-centered care through increased clinical integration of primary, specialty, and other care, with a particular emphasis on behavioral health and through use of virtual care and other novel care delivery modalities
Our health plan is strongly committed to this statement and has begun taking steps in line with the resiliency framework.
- Leveraging our current APM model for primary care that features a hybrid FFS/Capitation split. Allowed a shift to supporting telehealth and for maintaining revenue to providers during the height of the pandemic. Continuing to evolve this model to support PCP stability and independence. This model applies across all busines lines
- Development of a proprietary data and analytics tool to provide population-based information with accurate detail and robust capabilities. Continually monitoring for algorithmic biases
- Robust support, including data sharing and financial support for our local HIEs as well as direct support of a population health tool native to the HIE in WNY to enable analytics for providers
- Enhancing reimbursement within the value-based model for telehealth and other non-traditional delivery methods
We have encountered some barriers in the pathway to accelerating APMs. A recent barrier is rooted in the impact of COVID-19 on the delivery system. This has seemed to create a withdrawal from discussing risk based APMs and has instead led to unit cost pressure which is counterintuitive to the need for stability. More persistent barriers over the last 5 years have been a reluctance to address inefficiency, and potential structural changes in the delivery of care.
The ChenMed family of companies, including Chen Senior Medical Centers, JenCare Senior Medical Centers, and Dedicated Senior Medical Centers, fully supports the Health Care Payment Learning & Action Network’s (HCP LAN) advocacy for Alternative Payment Models (APMs). ChenMed is committed to Category 4 Payment Models (comprehensive population based payments) and will continue to operate with effectively 100% of care delivered under this payment model. Operating this way has unencumbered ChenMed from limitations associated with fee-for-service models, or less comprehensive APMs, resulting in innovative and holistic care that delivers better health outcomes, reduced hospitalizations, high patient and physician satisfaction – even through the COVID-19 pandemic. Going forward, ChenMed is committed to continuous improvement in the ability to address health inequity, overcoming non-clinical barriers to access medical care, and whole-person well-being.
Oak Street Health is an organization of value-based, primary care centers for adults on Medicare. With a mission of rebuilding healthcare as it should be, the organization operates an innovative healthcare model focused on quality of care over volume of services, and assumes the full financial risk of its patients. Oak Street Health was founded in 2012, purpose-built to thrive in our value-based future. The company delivers care that is personal, equitable and accountable within globally capitated contracts in partnership with numerous health plan partners around the country. As of September 17, Oak Street cares for patients at 66 centers in 9 states (Illinois, Ohio, Michigan, Indiana, Pennsylvania, Rhode Island, North Carolina, Tennessee and Texas). Plans for the rest of 2020 include an additional 6 to 8 anticipated center openings and expansion into New York and Mississippi.
As a result of this value-based platform, Oak Street Health's patients enjoy high quality outcomes and patient experience, namely: 51% reduction in hospital admissions, 5-Star ratings on HEDIS Part C Measures for patients with 12+ months tenure, and a Net Promoter Score of 90. Additionally, 95% of its providers would recommend Oak Street Health to other clinicians as a great place to work.
We at Oak Street Health commend the Centers for Medicare and Medicaid Studies for their thoughtful leadership toward our value-based future, and commit to ongoing operations in value-based models that deliver evidence-based, equitable, and financially accountable care to patients, as this truly is what is required to rebuild healthcare as it should be.
The COVID-19 crisis showed Rio Grande Valley ACO participants that population-based payment models allow our providers to worry less about office- based volume and to innovate in population management strategies and home-based care. We want to be part of the solution to deliver better and more cost-efficient care.
- Currently we are an Enhanced Track ACO; by 2022, we aim to become a CMS- Direct Contracting Entity and to continue moving away from FFS and toward Category 4 APMs.
- We aim to continue our telehealth adoption, delivering at least 20% of virtual visits in 2021.
- Our commitment to value also extends to an increased effort to integrate behavioral health strategies into our practices.
- Re-engineering primary care processes through this pandemic propelled each of our participants to ensure that value-based workflows were immediately implemented.
This crisis has only proven that value-based incentives strengthen our care delivery. However, it also exposed the care delivery system’s inequities as underserved populations were hit the hardest. We must continue doing better.
Walmart has a demonstrated commitment to payment reform as a way to drive better health and wellbeing for our associates. We have a history of pursuing alternative payment models through initiatives such as our Centers of Excellence program and bundled payment models with providers. The company is committed to making quality health care more accessible and affordable for associates, customers and the communities it serves.
Premier continues its longstanding commitment to working with healthcare providers across the continuum of care to move from a fragmented, misaligned fee-for-service system to one based on delivering value for patients and consumers. For nearly two decades Premier has organized health systems in data driven, performance improvement activities to bolster success in alternative payment models (APMs). Premier is focused on promoting a healthcare system that is resilient and transitions to effective APMs by:
- Ensuring success of two-sided risk Medicare APMs. Premier has organized more than 450 hospitals and thousands of clinicians implementing alternative payment models in data-driven collaboratives. These collaborative members in ACOs and bundled payments have consistently outperformed the nation in quality and reducing costs, despite having benchmarks below the national average. A critical component of our collaboratives has been rapid sharing of best practices and innovations. Our goal and commitment is to continue to expand these collaborative and for its members to continue to achieve superior performance in both quality and costs savings for Medicare, as they have for the past 8 years.
- Engaging purchasers and payers in the design of APMs. Premier has launched Contigo Health, which partners large, national employers with center of excellence health systems in select markets to deliver the best, most appropriate care possible for their employees. Additionally, Premier supports providers engaging in APM arrangements with Medicaid and Medicaid MCOs, Medicare Advantage and other commercial insurers. Our goal and commitment is to continue to grow the number of Premier members engaging in advanced APMs across payers and efforts to develop targeted market solutions with employers.
- Enabling Real Time Data Access at The Point of Care. Across all efforts to advance value-based arrangements, Premier works to combine clinical, supply chain and claims data and analytics to inform providers in their quest to deliver cost-effective, evidence-based healthcare. This includes integrating multiple sources of data including sources that support monitoring for disparities and addressing social determinants of health, benchmarking across providers, real-time clinical surveillance and clinical decision support to improve care practices. Our goal and commitment is to continue to enable data sharing and enhanced data analysis across healthcare entities so they can deliver evidence-based care at the lowest costs.
We remain committed to working with healthcare providers and policymakers to achieve continued success in these APMs.