The COVID-19 pandemic has laid bare some of the shortcomings of the nation’s health care infrastructure. Health care providers participating in traditional fee-for-service payment arrangements were negatively impacted by the pandemic as they experienced a sharp increase in expenses paired with significantly reduced revenue and a drop in opportunities to provide needed care.
Trinity Health was able to draw from the experience built over nearly a decade of improving population health through APMs to readily respond to the COVID-19 pandemic in communities both clinically and operationally. The clinical team within a population-based delivery model is skilled at assessing and identifying the needs of the whole person. Thus, Trinity Health teams were able to quickly apply the same expertise used to manage patients attributed to an APM to develop a whole-person plan of care for all patients at risk for COVID-19.
For example, care teams in the Syracuse, New York ACOs were able to create patient-centered care plans for more than 13,000 individuals who were at increased risk of morbidity and mortality from COVID-19 due to underlying clinical conditions. These teams taught sign and symptom management, ensured patients had their medications, and took other preventative measures to ensure they stayed safe and healthy. The teams were able to quickly apply the work they regularly do for patients who have chronic disease, to respond to COVID-19 impacts for patients attributed to their ACO and for those in traditional fee-for-service payment models.
Trinity Health has 16 Clinically Integrated Networks that serve as the operational home for APMs in their markets. The existing operational capabilities that Trinity Health developed to support the work of APMs were invaluable to the COVID-19 response. The majority of physicians in the communities served and in Trinity Health APMs are independent providers in their own practice. Trinity Health was able to immediately deploy support to these providers to help them respond to the COVID-19 pandemic. Trinity Health created communication tools to provide physicians access to telehealth, clinical information, guidance for use of personal protective equipment (PPE), access to pricing discounts for PPE, and patient-facing materials and support. In addition, daily communication with updated information from the CDC was provided and the Trinity Health pandemic response team was made available for guidance and support. Among other things, these experts offered understanding in federal and state waivers, funding opportunities, and the expansion of telehealth flexibilities.
Trinity Health’s experience responding to COVID-19 reinforced the importance of APMs—particularly population-based APMs that are based on expected rather than historical costs—to create and support health system resiliency. These payment arrangements scale and translate effectively while fostering innovation and collaboration.
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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.
