A Multisectoral Approach to Patient-Centered Care

The Healthcare Leadership Council (HLC) hosted a webinar focused on how various healthcare organizations have approached value-based care and the outcomes associated with those methods. While, historically, providers have been financially compensated for the volume of services they provide, it has been increasingly recognized that a holistic view of patients’ health includes additional lifestyle factors and results in a healthier population while reducing the cost of care. The panel consisted of four expert representatives from HLC’s membership.

Dr. Adam Solomon, chief medical officer of MemorialCare Medical Foundation, compared traditional fee-for-service (FFS) care to different types of accountable care organizations (ACOs), highlighting the notable difference in relationships between services and payments, as well as outcomes. Lack of coordinated care in a FFS system leads to a separation of clinical data, pharmacy data and claims data, whereas ACOs enable the communication necessary to provide a coherent record of the patient’s medical history. Dr. Solomon mentioned the importance of incentivizing innovative alternative payment models outside of Medicare, and also stated that Congress and CMS should continue to support the migration from Medicare FFS to value-based Medicare Advantage to ensure seniors have access to coordinated care, which improves both patient experience and outcomes.

Dr. Justin Barclay, vice president of consumer insights and analytics at Tivity Health, discussed how his organization partnered with HLC on a study of care coordination perceptions among FFS enrollees, using a nationally representative sample of seniors aged 65 and over who are enrolled in FFS Medicare coverage. Some key takeaways from this study include: seniors in FFS Medicare agree that care coordination leads to better healthcare decisions and increases access to quality healthcare; despite high awareness, only four in ten seniors have experienced care coordination; and seniors who have experienced care coordination place greater trust in their primary care physicians, specialists, pharmacists and health plans over social media and traditional news media. Dr. Barclay recommended further research to examine the differences in experienced care among underserved populations.

Dr. Mark Montoney, chief medical officer of Wellvana, explained the burnout experienced by primary care providers stemming from the burden of administrative tasks and poor work-life balance, while receiving less reimbursement for services than other types of providers. Addressing this dilemma, Wellvana manages three ACOs across 22 states, which provide support to providers in areas such as coding, care management and patient education. Dr. Montoney described how care constantly improves in this environment because ACOs cannot succeed unless patients and providers win first, and better care coordination results in shared savings for the care team through improved outcomes. He shared that ACOs have generated over $17 billion in gross savings for Medicare over the last decade and patients have received elevated care between visits.

Dr. Hirsh Sandesara, the lead medical director for value-based provider engagement at Blue Cross NC, described his organization’s efforts to rapidly build a network of ACOs across the state in order to balance rewards for better health outcomes and lower cost of care rather than incentivizing a greater volume of services. This transition has led to a significant and sustainable long-term impact on quality and affordability. The data for the 1.4 million members has shown increased screening for colorectal cancer, improved management of high blood pressure and a reduction in hospital readmissions. These improvements in quality have translated into reduced healthcare costs, with a cumulative of nearly $500 million in savings since 2019, and over $300 million going back to providers as incentives for maintaining the health of their patients. Blue Cross NC is committed to bringing payers and providers to the same table to collaborate most effectively toward a patient-centric system.