Treating individuals with co-occurring health conditions and social needs is proving a great market opportunity for working with value-based focused managed care organizations (MCO). The question on the table is, how do you close the gaps in care? Increasingly, the answer is “whole person” care.
Earlier this year I had a chance to hear Leigh Davison, Staff Vice President, Medicaid and LTSS Specialty Organization at Anthem, speak about whole person care during her keynote presentation, Innovative Collaborations & Partnerships For Long-Term Services: The Anthem Perspective, at The 2019 OPEN MINDS Performance Management Institute. During that discussion she laid out Anthem’s efforts toward whole person care by coordinating health, behavioral health, and social services. Housing, transportation, and nutrition are core elements. Technology is also a core element, as is a shift to value-based reimbursement (VBR).
But there was another phrase during Ms. Davison’s session that caught my attention—”person-centered organizations” (see In Managed Long-Term Care, Whole Person Takes One Step Further). For more on what this is, and how it feeds into whole person care, I recently spoke with Ms. Davison. “Whole person care” is about coordinating health, behavioral health, and social services. A person-centered organization is one that places the wants of the individual at the center of all health care decisonmaking; builds a care team around the individual and their caregivers; and creates personalized care plans to meet the needs of each individual (see How to Practice Person‐Centered Care: A Conceptual Framework). Ms. Davison explained that they are similar, but different, noting:
When you look at person-centered care, it is about looking at the individual and understanding what is important to and for them. How do you make sure that you understand their goals and preferences? That will drive their care plan. If you understand what is important to and for someone, and what’s driving them, then that better helps you support them with everything they need.
When you look at whole person care, it’s about looking at the care holistically. What is medical acute, what are the support services that may be needed to wrap around them? A lot of time we intertwine both person-centered and whole person care, and I think sometimes they can be the same, but it all goes back to being person centered. If you are looking at the care plan holistically and you don’t understand what is important to and for an individual, how are you going to ensure whole person care?
How do you assess if your organization is a person-centered organization? The Health Care Transformation Task Force (see Addressing Consumer Priorities In Value-Based Care: Guiding Principles and Key Questions) lays out six guiding principles for becoming a person-centered organization:
Include patients as partners in decisionmaking—Provider organizations need to make individuals “integral partners” in all aspects of health care decisionmaking by building infrastructures that allow them to weigh in on governance, oversight, program designs, and performance measures. In addition to the infrastructure needed, organizations need to have a culture in place that will respect an individual’s input and seeks to further engage them.
Deliver person-centered care—Individuals are not just treated by care teams; they need to be at the center of those care teams with access to a clear and reliable point of contact on the team, always. From there, provider organizations need to invest in care coordination models, individual-centered workflows, and delivering transparency.
Design APMs that benefit individuals —The goal of alternative payment models (APMs) isn’t only to achieve cost savings for the provider organization and the health plan, but to deliver higher quality care that improves individual outcomes.
Drive continuous quality improvement—”Person-centered” isn’t a transformation like buying a new piece of tech or adopting a new service line; the transformation must be ongoing, always, and continuously drive the organization to improve quality. Individuals must always be engaged with the organization and their own health care, and the organization needs to constantly drive performance improvements based on measurement and metrics-based management.
Accelerate use of person-centered health information technology—Person-centered thinking and operations is a tall order made impossible without the proper tech investments. Health IT must be built around supporting person-centered thinking and operations by collecting and analyzing the necessary health data and performance data, and sharing the relevant data with other stakeholders to support care coordination around the individual.
Promote health equity for all—Provider organizations need to “meet individuals where they are,” and provide the supports different and vulnerable populations need. This includes community-based support, social determinants of health (SDH), personalized services for at-risk populations, and methods for addressing health disparities.
My takeaway—these six principles are dependent on a broader service delivery system, one that is collaborative across multiple stakeholders and offers expanded services to support individuals in the community (see LTSS Drives Whole Person Care Strategies). But no service delivery system can deliver on either person-centered or whole person care if the organizations in that system have not adopted this approach. Ms. Davison noted three strategic priorities for any organization—whether that is a payer or a provider organization—that have helped drive Anthem in this direction:
Leadership—Strategy and commitment at the highest levels of an organization must align for a successful adoption of a person-centered thinking that places importance on the functionality and overall needs of the individual. Ms. Davison explained:
We made the investment a couple years ago, and it was important for us at a leadership level to change the mindset. You also have a lot of individuals that are in health care that mainly focus on medical. It isn’t a “check the box” but you have your steps of what you go through, and you have your clinical guidelines that you follow as your framework based on the individual’s medical needs. But when you start looking at other support services, it really comes down to functionality and a functional assessment, so it’s non-medical at that point. How do you change the mindset of how to support individuals? You must have that change at the top to permeate down or you will not be successful.
Communication—How do leaders communicate a new vision, any new vision, and positively affect a culture change to move the organization in a new strategic direction? That sounds like a basic change management problem, but when organizations are adopting person-centered care, communication channels must also be built from the organization to the individual. This added step is difficult but will ultimately feed into any whole person strategy. Ms. Davison explained:
We felt investment was huge for us as an organization, as we looked at the growing aging population which is just exploding. You really must understand and be person-centered, or you won’t be able to meet an individual’s needs. If you don’t know what is important to and for them, then you can’t ensure that they are getting the preventative care, or ensure they are getting the supports they need to live their best life. Do they want to be involved in the community and how do you help them access that? Is it through transportation? Is there access to telemedicine? You know, all those pieces must be communicated. You must start first at that basic level.
Time commitment—Many provider organizations are grappling with the need to change and to change quickly. But person-centered thinking isn’t a “turn on a dime” commitment. It takes time to re-imagine all the organizational processes necessary to support individuals, as well as coordinate the care system to deliver on an individual’s needs. Ms. Davison explained:
When we made the change a couple of years ago, it came down to working with Support Development Associates, and asking them, how can you work with us as a large managed care organization? We know this isn’t going to happen overnight. We know this is going to be a period of a couple of years and it will still be ongoing after that. We can’t say that in three years we are going to be done. You are constantly evolving the organization. When you think of going from leadership down, change also comes back up because it’s bi-directional.
As you look at many organizations, many are not willing to invest the time. What they will say is, we are going to have individuals that understand what person-centered thinking is and how to apply that philosophy to meet federal guidelines that require you to do person-centered planning. It’s a matter of what level you want to provide that training and commitment in the organization and how do you support it to build that bench strength to solidify it.
Why should you make this investment as a provider organization executive? While definitive findings aren’t out yet, preliminary research shows better individual recovery and emotional health with fewer diagnostic tests and referrals (see The Impact Of Patient-Centered Care On Outcomes); and better individual satisfaction and self-management (see Patient-Centered Care And Outcomes: A Systematic Review Of The Literature). And, for more on the long-term services and supports market, check out our recent analyses:
- The Shifting Long-Term Services Market: A Strategic Guide To Support Services For Complex Population
- The Medicaid MLTSS Market Shift
- In Managed Long-Term Care, Whole Person Takes One Step Further
- The Formula For Success In Long-Term Services & Supports
- LTSS Drives Whole Person Care Strategies
- LTSS Investment-& Restructuring- Speeds Up
For more, join us at The 2019 I/DD Executive Summit in New Orleans on Monday June 3. The Summit is designed to give executive teams the strategic tools they need to build sustainable organizations in a value-based world. This year, the Summit is focused on helping organizations build a business model focused on improving performance outcomes, preserving consumer self-direction, and exploring new partnerships across the care continuum.
And for more on the evolution of managed care, check out The 2019 I/DD Executive Summit session, “From Managed Care Planning To Execution-The Future Of Financing & Service Delivery Models For The I/DD Market” featuring Josh Boynton, Vice President of Aetna Medicaid.