Alternative Payment Models Conference: 5 key takeaways

LundquistA diverse group of healthcare stakeholders recently met for CBI's Alternative Payment Models in Healthcare Conference 2016 in Orlando, Florida.

After chairing the two-day event, my overwhelming observation is there is great reason to be hopeful about the future of healthcare-our evolving payment models are supporting great innovation across healthcare delivery systems.

The recurrent themes of the conference were population health management and the payment models arising to support achievement of the Triple Aim. Attendees included providers and senior leaders from payer organizations, health systems and big pharmaceutical companies.

Key takeaways:

1. Innovative organizations are already reaping the benefits. Speakers from PwC set the stage by reminding us of the convergence of forces offering momentum towards value-based reimbursement. While many health systems may not fully commit the necessary resources to support population health, most are beginning to make strategic investments in new clinical processes, people and analytics to support the evolution of healthcare, aimed at delivering better value.

Leaders, however, must fully commit for investments to materialize. For those committed, rewards are already forthcoming on strategic investments in managing the changing landscape of payment models and care delivery.

2. The best examples of new payment models supporting population health management come from collaborative partnerships between health systems and one or two payers, along with commitment from providers and community resources for comprehensive care coordination and redesign. A few presenters even offered surprising models of comprehensive, labor-intensive, focused care management with high levels of success for improved clinical outcomes, cost efficiency and provider and patient satisfaction.

Peter Boling, MD, from Virginia Commonwealth University Medicine shared his experience of the highly successful “Independence at Home” model, supported by Center for Medicare & Medicaid Innovation Center (CMMI) funding and recently renewed in 2015. In this model, physicians and members of their team visit patients who are “too sick to come to the clinic,” but frequent emergency departments and inpatient settings due to complications of multiple co-morbidities and mobility issues.

This home visit, provided slightly more often than once per month, improves overall care quality, cost efficiency and patient and caregiver satisfaction. It also creates a sustainable return on investment through significant, measurable clinical improvement. This is a model we should further replicate in all markets under value-based reimbursement for the right population of patients.

Next: Community-based, high-touch programs aid in addiction management

3. Community-based, high-touch programs aid in addiction management.  Another groundbreaking program, focused on substance abuse, was shared by Andrew Vitullo of BioCare Recovery. Breaking the integrated behavioral health trend, BioCare's model focuses on patients suffering from addiction. Andrew and his team have seen remarkable results with the community-based, high-touch and high-expectation program for patients saddled with the "chronic brain pathology" of addiction.

Recognizing addiction as a chronic disease has allowed Vitullo’s team to move past common episodic treatment and redefine successful outreach and engagement with this challenging population. This effort has led to impressive results, including improved long-term engagement, lower relapse rates and more longstanding recovery.

As both models above indicate, a fresh look at longstanding problems is often necessary. The redesign of treatment pathways and novel approaches to patient engagement are essential to success under new models of risk-based payment and value-based contacts.

The patients’ needs must remain at the forefront as we seek redesign, eliminate hierarchical approaches to create more effective connectedness to our patients and remove outdated thinking to shed new light on what patients really need. 

This was clearly demonstrated by other key stakeholders in healthcare who made significant impacts on total cost of care.

4. Oncology models that drive high-value care through provider-driven pathways are becoming more commonplace. Blasé Polite, MD, University of Chicago Medicine, focused on the good work in oncology such as the adaptation of key quality and patient satisfaction measures under models like those supported currently by CMMI, ASCO and some leading oncology practices. While he cautioned we still face challenges gaining physician support of value-based payments, strong payer and provider leadership is emerging.

Oncology models driving clinical appropriateness of treatment through provider-driven pathways are becoming more common. Improved quality of side effect management and better management of patient and family expectations are becoming promising areas of research and care model redesign.

Oncologists are tackling high impact, but sensitively-charged, areas of care such as improving patient outcomes through increased use of palliative care and decreased use of ICU at the end of life. This is all happening while keeping an eye on costs improvement.

Any discussion of oncology costs quickly turns into questions for the pharmaceutical industry, and we were fortunate to have key leaders from two large pharmaceutical companies in attendance.

In formal presentations, panel discussions and lively Q&A sessions, these leaders discussed how their companies are redefining their business approaches. They recognized the need to move from historical brand launches toward the entire value which their products bring to market.

That value, they agreed, will not be limited by sales volume of a clinically effective drug. More importantly, it will be measured by improvement in medication adherence, standardized patient education and engagement tools, and potential care coordination efforts integrated with care teams under clinically integrated networks and accountable care organizations. Future pharmaceutical company integration into care paradigms gave all in attendance a great sense of optimism for future possibilities.

5. Technology continues to present great opportunities for high-value care. During the conference, many great examples of population health management's evolution were shared along with the impactful relationships being forged between federal, state and commercial payers with many leading healthcare organizations. Since these are covered in many publications, I will conclude with a topic which no modern-day alternative payment model conference would be complete without: technology.

Cloud-based applications and social networks continue to create opportunities for patient education, engagement and empowerment. These solutions are transforming data collection and integrating data streams, including patient feedback through disease-specific social media communities and rating sites.

While it was agreed such new technology could be misunderstood and, occasionally, misdirected, technology has a pivotal role in the rapidly evolving landscape of population health management and will undoubtedly transform healthcare delivery for the better.

The conference exhibited that although healthcare landscape changes may be numerous, they are creating a path towards a stimulating future of innovation and improved patient care.

Thomas Lundquist, MD, MMM, FAAP, FACPE, is the senior vice president and chief medical officer, Optima Health. He served as chairman of the Alternative Payment Models in Healthcare Conference 2016.