This year at The 2018 OPEN MINDS Performance Management Institute, we had the chance to hear from the executives of a number of provider organizations and health plans who are actually making value-based reimbursement partnerships work. While the models were all slightly (or very) different, the key elements in successful partnership resonated across the presentations.
These core principles were illustrated in the presentation by Deborah Adler, Senior Vice President, Network Services of OptumHealth and Anthony Belott, Chief Development Officer of CleanSlate, in their session, Developing A Value-Based Partnership: The Optum Case Study. The partnership uses a monthly bundled payment to deliver medication assisted treatment. What were their core principles for success?
Identify a problem and market yourself as the solution—The partnership developed around Optum’s need to expand access to evidence-based addiction treatment providers. Like most of the country, Optum is trying to help address the opioid crisis, and has developed a number of initiatives to support its members, including incentivizing members to get treatment from providers that use evidence-based practices, offering a toll-free substance use disorder (SUD) treatment helpline, developing a preferred SUD provider network, and implementing program network integrity initiatives to address common challenges, including over-utilization of laboratory services.
CleanSlate, an organization that provides medication assisted treatment and adheres to the American Society of Addiction Medicine (ASAM) guidelines, fit well with Optum’s goals. The organization was also tracking metrics and had sufficient access to capital to move into areas where Optum had hotspots (i.e., high volume of members admitted to inpatient/residential programs with opiate use disorder).
Be creative and negotiate—Working out the model and coming up with solutions to the various operational issues, such as data collection, financial risk profile, and credentialing, takes creativity. Maintaining an open dialogue and regular meeting structure was key to developing solutions along the way. Through their negotiation process, Optum and CleanSlate developed a monthly bundled rate that includes a single payment for all services associated with MAT (lab costs, psychosocial supports, care coordination, and medication management) exclusive of pharmacy. This model allows CleanSlate to provide a higher touch service to its consumers, and lowers the consumers’ out of pocket expenses. They pay once a month instead of per visit, and this allows CleanSlate to do the lab testing and employ anti-diversion measures they need to ensure that consumers are not abusing their prescriptions.
When talking about their payment model both Ms. Adler and Mr. Belott reiterated that it is important to start slowly. These models are new for both the health plan and provider organizations. And organizations don’t have to completely move to the level of highest risk, or even the highest level of savings, all at one time. Optum and CleanSlate started with a bundled rate and as the model gets up and running, they intend to explore other models.
Keep talking and show results—The key to making the model work in the long-term is continuous contact with each other and the ability to share data. CleanSlate and Optum teams meet weekly to evaluate processes to help drive appropriate utilization and work within the infrastructure to connect individuals to the appropriate level of care.
Key to Optum’s selection of CleanSlate as a provider partner was its ability to demonstrate measurable results. CleanSlate monitored a cohort of members and compared their six months prior to starting the program and six months after finishing the program. As a result of the program, CleanSlate’s patients had a 35% decrease in emergency room visits and a 25% decrease in inpatient admissions. Its payor partner reported a 35% decrease in total medical spend. In a separate internal study examining intravenous drug using patients, 5.4% of the patients became hepatitis C positive after 12 months, which compares favorably to the 24-month national conversion rate for a comparable population.
Developing a value-based model of care isn’t one size fits all. It’s about doing the research to identify a problem, positioning yourself as the solution, and then negotiating a payment model that works for both organizations. Then as the model gets up and running it is important to stay in contact with the payer and continue talking and sharing results.
To learn how to implement a bundled rate at your organization, be sure to join us at The 2018 OPEN MINDS Strategy & Innovation Institute on June 5 for the session, “How To Develop A Case Rate: A Guide To Bundled Payments”, led by Ken Carr, Senior Associate, OPEN MINDS, and featuring Paul Duck, Vice President, Strategy & Development, Beacon Health Options.