November 16, 2018

Our Transition to Value-based Care: How Partners HealthCare is Battling the Rising Costs of Care and Putting the Focus Back on the Patient

McCleary and Young review data

Molly McCleary and Meaghan Young review performance data for Value Based Care contracts.

For most of modern medicine, health care providers were reimbursed per service delivered. This fee-for-service model incentivized providers to order more tests, perform more procedures, and manage more patients. As a result, the health care industry quickly began spending more to treat patients without necessarily improving patient outcomes.  And these increasing costs began to crowd out spending on other important areas such as education, housing, and infrastructure.

To address the ballooning cost of health care spending and put the focus back on patient outcomes, new payment models emerged to incentivize health care systems to think differently about how we deliver care. These new models focus on cost containment, with the goal of keeping health care cost growth at or below the rate of general inflation. Over the last few years, Partners Population Health has helped Partners HealthCare on its journey toward value-based care.

A NEW CONCEPT FOR CARE 

Value-based health care is a health care delivery model in which a health care system and its providers are paid based on patient health outcomes versus the number of services they provide. The “value” is determined based on the measurement of a patient’s health outcomes against the cost of delivering their care.

“Population Health innovations are enabling providers to more efficiently meet their patients’ needs,” says Meaghan Young, Program Director for Performance and Strategic Projects at Partners Population Health. “If a primary care provider (PCP) has a question about a patient’s symptom, they can use our e-consult program to connect to a Partners specialist in real time instead of referring the patient for another medical appointment with a specialist. It’s the same outcome in a much more timely, patient-friendly manner. These types of innovations are not supported in a fee-for-service model.”

Value-based care can be structured in several different — bundled payments, the Patient Centered Medical Home model (PCMH), and the Accountable Care Organization model. Utilizing population health management strategies, Partners entered into Accountable Care Organization arrangements and has helped 97% of our primary care practices gain PCMH certification through the National Center for Quality Assurance (NCQA).

ADVANTAGES FOR ALL

Patients

Value-based care models focus on helping patients recover from illnesses and injuries more quickly and to avoid onset of chronic disease in the first place. As a result, patients face fewer doctor’s visits, medical tests, and procedures, and they spend less money on prescription medication. Quality measures and patient registries help Partners stay accountable for treating patients with chronic problems. The programs supported by Partners Population Health, such as high-risk care management, help patients and their providers coordinate their care to manage these conditions.

Providers

Effectively managing a chronic condition like diabetes, high blood pressure, COPD, or obesity can be costly and time-consuming for providers. The fee-for-service model doesn’t reimburse providers for the time it takes to coordinate care, address social determinants of health like food or housing insecurity, and take a whole-person view of care. While providers may need to spend more time on new, prevention-based patient services, they spend less time on acute episodes that stem from poorly managed chronic disease management such as emergency room visits or inpatient stays. Quality and patient engagement measures increase when the focus is on value instead of volume.

Payers

Value-based care aligns incentives between payers and providers by rewarding providers for keeping patients healthy. This May, CMS announced that for the 2016 performance year the Next Generation ACO Model generated net savings to Medicare of approximately $62 million.  On the commercial side, a recent study showed that commercial payers are investing in value-based innovation faster than previously projected levels.

Society

Value-based care means less money is spent helping people manage chronic diseases and costly hospitalizations and medical emergencies. In the United States where health care expenditures account for nearly 18% of Gross Domestic Product (GDP), value-based care has the promise to significantly reduce overall costs spent on health care.

INNOVATION FROM WITHIN, AND ABROAD 

Partners HealthCare continues to be a leader testing innovative value-based payment models. Our work participating and informing the Pioneer ACO pilot with the Center for Medicare and Medicaid Innovation (CMMI), incorporating the NCQA recognition process into our electronic medical records (EMR), and many other projects have served as test-beds both within our system as well as for nationally adopted models. As value-based care models become more ubiquitous in health care systems across the U.S., the Partners Population Health team looks forward to sharing lessons learned and collaborating with organizations focused on supporting this transition both within their organization, and in the health care industry at large.

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