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By Monica E. Oss

It’s always interesting to “kick the tires” on a value-based contracting model that is up and running—and working. Our team had that opportunity at The 2018 OPEN MINDS Performance Management Institute in the session, How To Develop A Value Based Reimbursement Agreement: The Centerstone/Passport Health Case Study, featuring Liz McKune, Vice President, Health Integration at Passport Health Plan and Kelley Gannon, Chief Operating Officer, and Debbie Cagle-Wells, Chief Marketing Officer at Centerstone.

In their presentation, they discussed two separate shared savings incentive programs that started in June 2017. One is based on a population management incentive that is looking at the health of the membership that receive services from Centerstone. In this model, Dr. McKune discussed the process of establishing several baseline clinical measures, with incentive payments tied to reduction in medical hospitalization, emergency department utilization, and reduction in inpatient behavioral health stays. Under this model, savings are shared if there is a reduction in spending in those three areas and if quality metrics are achieved, such as improvements in follow-up after hospitalization for mental illness; documentation of body mass index (BMI) with a plan to address BMI; tobacco use screening and cessation; and communication with primary care providers and referring providers at the initiation and discontinuation of treatment.

The other shared savings program—for individuals with serious mental illnesses—is in the pilot stage and is focused on savings related to reduced medical inpatient stays, reduced emergency department utilization, and reduced behavioral health inpatient stays. The intervention is an enhanced targeted case management intervention that includes 24-hour access to nursing, a focus on consumer activation, a focus on health needs, increasing access to resources to address social factors related to health, and measuring progress toward physical health goals. The incentive payment has two components, with half tied to achieving health savings and half tied to two quality metrics: measurement of patient activation and identification, and documented progress toward a health goal.

Debbie Cagle-Wells

Ms. Cagle-Wells described the relationship between the Centerstone organizations as a marriage:

Centerstone Kentucky joined the Centerstone family about 16 months ago. For us affiliations are marriages. The Passport relationship (with Centerstone KY) developed through a lot of conversations over and over again, and not just conversations about the contract. Centerstone’s Center for Clinical Excellence works to develop clinical models that we believe are best in science, looking at outcomes, and bringing those to five states. We do training and shadowing as part of our clinical model development and deployment, and it was part of what we brought to the Kentucky affiliation. It’s important to us to advance the science to get our members the best outcomes.

Ms. Gannon further explained that Centerstone had to demonstrate its value to the payer, and in Kentucky where Medicaid has been under managed care for five years, this meant devoting a lot of time to marketing that invites the managed care organizations (MCO) to share outcome data in a bid to support transparency. To do this with Passport, Centerstone established regular meetings and according to Ms. Gannon, “get their sea legs.” She explained:

Kelley Gannon

As a provider we weren’t there yet. To get our sea legs around that, it really took a while. What were our motivations? For us, to differentiate ourselves as a provider. Passport is unique for us as a state-based, non-profit managed care organization. They were huge for us and we really needed to build our relationship. We are on the ground, so we know if consumers are smokers, homeless, in jail, skipping appointments, and skipping medications. We know the complexity of their lives and we thought that we could give Passport something great, since they only had claims data. We also knew that integrated care was coming. We wanted to get on board quickly, and move on population health management.

At Passport, Dr. McKune began looking for trends and opportunities that might make a difference for the community and answer the question-how to work together to impact the whole person? This meant conversations about behavioral health homes, and enhanced targeted case management processes. The challenge, she explained, what that those members’ spending is highest on the medical side, and to get the shared savings, Passport needed to get some risk on the physical side. Dr. McKune said:

Liz McKune

On the MCO side, we look at the population. That’s a shift in thinking for providers, to think about the consumers’ whole health and how you can impact the whole group of people. The next thing was trying to figure out what information to we have access to? Claims data is all things that happen in the past (earliest info is at least 90 days old), but in terms of looking at the health of a person, I don’t think claims is the best way to look at that. We had to look at the kinds of information that should be gathered that impacts health more directly.

What can we learn from the Centerstone/Passport relationship? The path forward for value-based care partnerships is built on three basic principles provider organizations can adopt:

First, focus on common outcomes. Value-based care all comes down to improving outcomes and reducing costs. Service line development should be based on identifying gaps in care and adopting evidence-based practices to address population health so that you can demonstrate the impact of your services on the populations you serve.

Second, transparency is key. To build a partnership, you need to communicate your organization’s capacity for delivering the systems and services to meet health plan needs.

Third, be realistic about commitments. A strong relationship is build on an understanding of your program’s capacity and ability to deliver results. Don’t over commit what you are capable of and be clear about the results that you are able to produce. Before you enter a contract, you need to agree on the data you will share, the consumers you will serve, the financial result and clinical outcomes you will produce.

For more on the changing relationships between payers, health plans, and service provider organizations, join Charles Gross, Ph.D., the Vice President, Behavioral Health at Anthem, Inc., on June 6 for his keynote, “Going Beyond Innovation – Developing Partnerships With Health Plans” at The 2018 OPEN MINDS Strategy & Innovation Institute.

 

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