November 28, 2018

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The ACO model emphasizes a transition to value-based care, which rewards or penalizes organizations based on patient outcomes instead of the volume of services they provide. Providers must realign clinical workflows as well as revenue models, and physician leaders must convince their peers that these changes will pay off in the long run.  

Caravan Health is committed to helping organizations manage and minimize the disruptions of transitioning to value-based care so they can focus on their core mission - providing high-quality care to the patients that need it most. 

Dr. Anna Loengard is Caravan Health’s Chief Medical Officer and board certified in Geriatrics and Hospice and Palliative Medicine. Her previous role, CMO for the Queen’s Clinically Integrated Physician Network in Hawaii, emphasized physician alignment and population health services such as care coordination, behavioral health integration, and patient education. We asked Dr. Loengard to describe some of the key steps in achieving physician buy-in for the shift to providing more coordinated care. Last week we previewed Dr. Loengard’s presentation at the third annual Accountable Care Symposium that will be held on December 5 and 6 in Phoenix, AZ.  

As CMO, what is the key message that you are conveying to physician leaders about how Caravan Health can support them? 

Our goal is to provide primary care clinics with expertise and support so that they can hire staff to do a lot of the work of population health management and to receive payment for that work. We want to increase the quality of care that the clinics provide and increase the attention they pay to patients with complex chronic conditions, while taking work off the physician’s plate.  

One example is behavioral health. One of our national medical directors saw a huge jump in provider satisfaction. When he dug into the survey data, he realized the jump in satisfaction was the result of implementing an integrated behavioral health program. That made such a huge difference to the physicians, to have that support for their patients, to take so much work off their plate. It is about putting in structure and process to make sure the right care happens seamlessly. 

And we follow up this support by helping with the quality reporting that's required, such as the quality metrics for preventive screenings in value-based care models. 
 

Why are you emphasizing population health as opposed to primary care, which some competitors focus on instead? 

Our initial focus is in building out robust primary care, but that will only take us so far. It's a building block. There's a lot of opportunity for us to use our analytics tools, to use the spending data we have to dial in and identify the next opportunity to cut costs in the system in each community we support. 

Post-acute care is one obvious place. A lot of communities just don't have home-based and community-based services for patients who don't want to be in the hospital. This is going to be a big crisis. Where do we care for these patients – and how? At the same time how do we make sure these services are being used appropriately, to support patients in avoiding hospitalizations, but not overusing either. Our analytics provide insight into where the opportunities lie for each of our ACO participants. 

Another is end-of-life care; we have the ability to see into each community how much hospice care is being provided to those patients, how many days are people spending in ICU at end of life, etc. Having long hospital stays at the end of life doesn’t always make sense for patients. 

When I started doing this work, there was definitely a feeling that this is “check-the-box” quality, that it’s not improving the outcomes – or lives – of patients. It’s encouraging to see that a lot of our doctors, by and large, do believe that this is helping them provide higher-quality care to patients, that this increases the amount of prevention and wellness care that their patients are getting.  
 

What is holding hospitals and health systems back from achieving success in value-based reimbursement models? 

Making this kind of change in health care is hard. It’s a struggle to actually get physicians to agree on best-practice guidelines that might diminish their revenue if they have a margin of two to three percent.  

If we're reducing costs in a system, somebody's going to lose revenue. How do you do that in a way that doesn't ruffle too many feathers? It’s always a challenge to ask providers to reconsider their business model. The recent MedPAC report discussed this question of revenue for  hospital-based ACOs. They found that hospital-based ACOs are not reducing inpatient or outpatient revenue but are realizing savings from changes in post-acute care.   

"It’s encouraging to see that a lot of our doctors, by and large, do believe that this program is helping them provide higher-quality care to patients."
 

How do you achieve physician buy-in for programs that require them to change their behavior?  

You have to understand that one size doesn’t fit all when it comes to overcoming obstacles to ACO success. Primary care physicians tend to be motivated by three factors: Improving care for their patients, decreasing the time they spend doing things they don’t enjoy, or improving their own quality of life.  

You also have to make sure that everyone is incentivized in the same direction. If the hospital or whoever owns the clinic wins financially, then the physicians should benefit financially as well, particularly in primary care where the bulk of the initial work needs to be done. If the ACO does well, the physicians must benefit. These are the engines that make accountable care work. If you're not compensating physicians in a way that motivates them to do this work, it's not going to succeed.  

As a physician leader, you need to understand your audience, you need to be able to broker between the administrators and the physicians, and you need to understand the needs on both sides – and that’s how you end up with a win-win. 

Learn more about physician buy-in by tuning into Dr. Loengard's webinar: Ace Quality & Population Health, by Doing Less Work, Smart. 

Watch the webinar now

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