Dr. Jamo Rubin is Founder and CEO of San Antonio-based TAVHealth, a cloud-based platform for complete patient care. A former cardiac transplant anesthesiologist, Dr. Rubin founded and led Medical Present Value, a contract management and revenue cycle company (now Experian Healthcare) and PTRX, a consumer-oriented pharmacy benefits manager (now Catamaran). He also co-founded and led Tenzing Health, a division of Vanguard Health Systems. In this point of view, he shares his perspective on how to build a successful “fee-for-value” network:
Premier, Inc.’s spring 2016 Economic Outlook survey revealed remarkable agreement among health leaders when asked to identify their most pressing need today. Ninety-five percent of those surveyed — mostly health system C-suite executives — said that “high-value post-acute care networks will be a key area of focus over the next three years.” Premier attributes this to shifting payment policies that are leading health systems to explore “where, how, and with whom they should partner and interact to enhance population health.”
Building an effective post-acute care network is one important step toward successful fee-for-value care. Look for the next step to be additional payment policy changes that encourage full-spectrum care networks; in other words, care designed around the patient that includes not just the care plan, but also transitions and care settings.
Step 1: The post-acute care network
Health leaders are concentrating on post-acute care networks first because payers are incenting them to reduce avoidable readmissions. Hospitals are paying more attention to patients’ progress after discharge. Now, they are tracking patients as they move back home, or to rehabilitation facilities, skilled nursing homes, or long-term acute-care hospitals.
Providers are generating better outcomes as a result, with simple changes in how they approach post-acute care. For example, CMS recently recognized one hospital system for reducing all-cause 30-day readmission rates among heart failure patients from 17.8 percent to 8.2 percent. The hospital system replaced the concept of “discharge” with “transition,” which emphasized improved patient education and engagement, community collaboration, and solving for social and financial determinants of health.
This example illustrates that success is just as much a matter of thinking differently about patient care as it is about implementing new information technology. The goal has changed; it is to follow and assist patients and their families through often difficult and overwhelming transitions. Doing so will help achieve the care quality already embedded in care plans.
Early activation of a powerful collaboration network focused on a person’s successful health journey will deliver on the promise of value-based care: better outcomes, lower cost, and a better experience for everyone. - TAVHealth CEO Jamo Rubin
Step 2: The complete care network
The next step in advancing fee-for-value is to encourage provider networks to commit to a true health continuum. Starting with primary care, it requires real dedication to coordination and collaboration, following patients throughout their journeys in both sickness and health. So far, early payment reforms have centered on reducing avoidable readmissions. Reducing all avoidable admissions will further advance fee-for-value.
As with reducing readmissions, improving outcomes while reducing costs throughout the care continuum will require new ways of thinking about care. Requirements for success will include:
- Changing the mindset from treating patients to helping people and their families. This is ultimately where fee-for-value models are headed. Providers will be compensated not for performing services on patients, but rather for helping people and their families reduce their need for care services. Illness happens to a patient, but sickness sits with the entire family. To succeed, we must place each person at the center of care with empathic thinking across all transitions and settings.
- Helping people be co-creators of their health. Clinicians at every stage of care transition should talk meaningfully with patients about their health. People are much more willing and able to align with action plans they help to create. But it means shifting from telling patients “what to do” to encouraging them to ask questions and providing them with actionable answers.
- Removing barriers to health. In addition to sharing a clinical view of patients, providers will need to record and share relevant psycho-social barriers with each other and with community organizations. Patients without transportation may need assistance getting to follow-up appointments, for instance. Those who can’t afford medications must be informed about options to obtain needed prescriptions. Solving for these social, financial, and community barriers can be as important to a patient’s outcome as clinical plans.
- Building workflows and systems that connect across entire care communities. Helping people move successfully through all phases of their health journeys will require new systems that share information across a network of connected providers and support groups — community organizations, hospitals, doctor’s offices, state services, and more — and assign that information to the correct individuals. Such sharing is crucial to efficient care coordination.
Moving from fee-for-service to fee-for-value will generate a far greater disruption of healthcare than we have seen to date from the need to reduce avoidable readmissions. But the initial emphasis on creating high-value post-acute networks is an important first step — a first down towards the ultimate goal of the Triple Aim. Early activation of a powerful collaboration network focused on a person’s successful health journey will deliver on the promise of value-based care: better outcomes, lower cost, and a better experience for everyone.