The outbreak of COVID-19 exposed a number of inadequacies in the healthcare system. As healthcare utilization fell dramatically across a range of settings, providers reliant on fee-for-service payment mechanisms were threatened with sudden, precipitous drop-offs in revenue, potentially threatening their ability to remain operational and continue to serve patients. Through its experience in clinical quality improvement, efficient healthcare delivery, and innovative payment models, Intermountain Healthcare was able to build on this unique moment to provide short-term assistance to its network providers while also moving toward consensus around more resilient, longer-term models of healthcare delivery and financing.
Intermountain Healthcare is a Utah-based integrated delivery network consisting of hospitals, physicians and advanced practice clinicians combined with a substantial health plan. Throughout its existence, Intermountain has strived to shift system payment away from traditional volume-based mechanisms toward value-based payment. Important to this is moving individual provider payment away from a pure fee-for-service (e.g., payment per relative value unit) toward mechanisms that drive value-based decision making. Prior to the pandemic, many clinicians remained understandably wary of alternative compensation models such as population or capitated payment out of concern that such models were risky endeavors. The onset of the pandemic demonstrated that volume-based payment arrangements carry their own risks, as physicians across the nation saw significant impact on their revenues.
In response to COVID-19, Intermountain sought to address providers’ short-term needs while also using this moment as a catalyst for more lasting change. As a first step, Intermountain guaranteed practitioners a set percentage of their 2019 take-home pay to give them time to adjust to the new realities of telehealth (and sometimes pitching in to provide COVID treatment that was outside of their traditional scope of practice). Intermountain then moved to engage practitioners in a collaborative effort to reimagine reimbursement mechanisms going forward at an accelerated pace. Coming out of the experience of the pandemic, Intermountain found that the provider community was more open to conversations around new models of payment. Many began to view population-based or capitated payment models not as a risk – but an opportunity for more stability. Our goal and commitment is to continue to realign payment mechanisms toward value-based incentives.
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Emily DuHamel Brower, M.B.A., is senior vice president of clinical integration and physician services for Trinity Health. Emphasizing clinical integration and payment model transformation, Ms. Brower provides strategic direction related to the evolving accountable healthcare environment with strong results. Her team is currently accountable for $10.4B of medical expense for 1.6M lives in Medicare Accountable Care Organizations (ACOs), Medicare Advantage, and Medicaid and Commercial Alternative Payment Models.
Mr. James Sinkoff is the Deputy Executive Officer and Chief Financial Officer for Sun River Health (formerly known as Hudson River HealthCare), and the Chief Executive Officer of Solutions 4 Community Health (S4CH); an MSO serving FQHCs and private physician practices.
Victor is the Chief Medical Officer for TennCare, Tennessee’s Medicaid Agency. At TennCare, Victor leads the medical office to ensure quality and effective delivery of medical, pharmacy, and dental services to its members. He also leads TennCare’s opioid epidemic strategy, social determinants of health, and practice transformation initiatives across the agency. Prior to joining TennCare, Victor worked at Evolent Health supporting value-based population health care delivery. In 2013, Victor served as a White House Fellow to the Secretary of Health and Human Services. Victor completed his Internal Medicine Residency at Emory University still practices clinically as an internist in the Veteran’s Affairs Health System.
Dr. Brandon G. Wilson, DrPH, MHA (he, him, his) joined Community Catalyst as the Director of the Center for Consumer Engagement in Health Innovation, where he leads the Center in bringing the community’s experience to the forefront of health systems transformation and health reform efforts, in order to deliver better care, better value and better health for every community, particularly vulnerable and historically underserved populations. The Center works directly with community advocates around the country to increase the skills and power they have to establish an effective voice at all levels of the health care system. The Center collaborates with innovative health plans, hospitals and providers to incorporate communities and their lived experience into the design of systems of care. The Center also works with state and federal policymakers to spur change that makes the health system more responsive to communities. And it provides consulting services to health plans, provider groups and other health care organizations to help them create meaningful structures for engagement with their communities.
Tamara Ward is the SVP of Insurance Business Operations at Oscar Health, where she leads the National Network Contracting Strategy and Market Expansion & Readiness. Prior to Oscar she served as VP of Managed Care & Network Operations at TriHealth in Southwest Ohio. With over 15 years of progressive health care experience, she has been instrumental driving collaborative payer provider strategies, improving insurance operations, and building high value networks through her various roles with UHC and other large provider health systems. Her breadth and depth of experience and interest-based approach has allowed her to have success solving some of the most complex issues our industry faces today. Tam is passionate about driving change for marginalized communities, developing Oscar’s Culturally Competent Care Program- reducing healthcare disparities and improving access for the underserved population. Tamara holds a B.A. from the University of Cincinnati’s and M.B.A from Miami University.
Dr. Peter Walsh joined the Colorado Department of Health Care Policy and Financing as the Chief Medical Officer on December 1, 2020. Prior to joining HCPF, Dr. Walsh served as a Hospital Field Representative/Surveyor at the Joint Commission, headquartered in Oakbrook Terrace, Illinois.
