“I can’t think of a recent conversation at Anthem that didn’t include value-based care. But, we can’t do value-based payment on an island. All insurance companies are interested in discussing a village concept of value-based care with consumer-centric provider organizations that have the infrastructure to do that. There are relationships all along that pathway, and while most organizations can’t be the whole village, they can be a significant piece of it.”
These remarks—made by Charles Gross, Ph.D., Vice President, Behavioral Health, Anthem, Inc., during his opening plenary address, Going Beyond Innovation-Developing Partnerships With Health Plans at The 2018 OPEN MINDS Strategy & Innovation Institute earlier this month—are words to the wise for any provider organization executive team developing strategy for the years ahead (assuming they are planning on health plan revenue as part of their income stream).
From the health plan perspective, there are some major hurdles to overcome. Dr. Gross discussed three key concerns—each of which have implications for provider organization strategy:
- Achieving network adequacy. Getting access to care, particularly access to psychiatrists and other high-demand specialists is an issue, and “better” (read: more attractive) payment models (see The Value-Based Reimbursement Steeplechase).
- Finding provider organization with the scale and capabilities to manage value-based contracts. There are some specific organizational capabilities needed to manage value-based arrangements and some requirements in terms of financial stability (see Financial Management Issues In Population Health Management: Preparing For Value-Based Reimbursement). For this reason, larger and resource-rich specialty provider organizations are more attractive to health plans (see Riding The Value-Based Wave).
- Developing a medical/behavioral health integration model. Many current VBR models have focused gainsharing on the primary care side of the equation—and a new model is needed that extends that gainsharing to behavioral health partners (see The Strategic Challenges On The Road To Value-Based Reimbursement).
Where is Anthem in a transformation to value-based reimbursement? Last year, Anthem Blue Cross executives announced that nearly 60% of its health plan spending during the first quarter of 2017 was through value-based care arrangements, including accountable care organizations (ACO) and patient-centered medical homes (PCMH) (see Anthem Blue Cross Nears 60% Value-Based Care Spending). Anthem is also focused on moving forward with VBR models for specialty provider organizations through several new programs.
The first of these programs that grabbed my attention is their new medical behavioral integration program (BHMIP)—what I see as curated partnerships matching behavioral health providers and primary care practices (PCP) in gainsharing arrangements. Launched in 2017, BHMIP pilots are operating in multiple states and utilize the standard outpatient quality and utilization metrics, while including additional focus on care coordination with PCP partners through care compact adoption and joint accountability for key physical health quality measures with behavioral health influences.
In addition, Anthem launched a gainsharing program for addiction treatment facility partners in 2017. The program is focused on promoting successful transitions out of inpatient/residential care with prevention of readmission back into a facility setting.
Dr. Gross also shared Anthem’s future plans for new models for contracting with specialists – calling the ACO and PCMH models unrealistic in their current engagement of specialty care. To address this, Anthem is working on specialty services (included behavioral) with new contracting models-acute and chronic bundles; payment for chronic management and e-consults; and a value-based fee-for-service (FFS) framework.
The future Anthem VBR model for contracting for specialty care presented by Dr. Gross is a roadmap to a more consumer-centric health care system—and it is also a roadmap for provider organization strategy (see What’s The Window To Value-Based Care? and Crawl, Walk, Run To VBR). And these efforts to find a health care financing system that facilitates both better consumer outcomes and a new “partnership” model with provider organizations is not limited to Anthem (see Getting Past The Bumps In The Road To Value-Based Reimbursement; Developing A Value-Based Partnership: The Optum Case Study; and ‘A Commercial Health Plan’s Perspective’: Magellan’s Philosophy & Approach To Value Based Payment Arrangements). But, this shift in the specialist landscape also changes the competitive landscape and the model for organizational sustainability. The big strategy question for specialist organization management teams is a plan to weather the transition.
For more, join John F. Talbot, Ph.D., Chief Strategy Officer at Jefferson Center for Mental Health, and OPEN MINDS Advisory Board Member, on September 19 at The 2018 OPEN MINDS Executive Leadership Retreat for his session, “The New Leadership Challenge: Culture & Change Management In A Value Based Market.”