From Side Deal to System-wide Adoption: Incentivizing Tomorrow's Comprehensive Care

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Traditional care and payment models don’t incentivize health, and are largely incapable of considering social drivers of health, equity, inclusion and more. This problem, identified by our recently released state-reports, was the central challenge of Cambia Grove’s recent hackathon partnership.

Building on learnings from our hackathon, we hosted a summit to address the need for cross-organizational collaboration when it comes to solving health care’s biggest challenge, in partnership with: Accountable Care Learning CollaborativeAmerica’s Health Insurance PlansPacific Hospital Preservation and Development Authority and Patient Orator. Participants’ alternative care and incentive ideas were eye-opening, optimistic for the future and mindful of how our current system evolved from past iterations. Check out some of the takeaways, videos and illustrations below.

How Policymakers are Incentivizing Value 

“How do we design financially sustainable models so that participants want to come in and make these changes in a sustainable way?”

Amy Bassano, Deputy Director for the Center for Medicare and Medicaid Innovation (CMMI) at the Centers for Medicare and Medicaid Services (CMS) shed light on the results of incentive models tested across the country, and how the move to value and incentivize health is being encouraged at the federal and state levels. She shared the three success measures outlined by the CMS Statute: 1) quality improves with cost staying neutral, 2) quality stays neutral with cost reducing and 3) the ideal scenario of quality improving while cost reduces. 

Check out a few takeaways from the presentation:

  • Cost and quality are equally important. CMS is continually working with partners to ensure they have the right quality measures, which must include health equity and access to care.
  • Alternative care and payment models must be continually refined, and CMS has the authority to test expand successfully models broadly.  It is important to be cognizant of participants in each model and assess whether they are representative of the population at large. We must apply an equity lens when testing and scaling new models. 
  • Success for CMMI will involve more models moving out of the testing phase and into expansion and more providers with them on the journey to value. 
  • When designing models, we need to ask ourselves “is anyone going to come to our party and if not, why? Are the proper incentives not aligned?”

Watch the full discussion here: 

 

How Did We Get Here? A Brief History of Incentives 

Dr. Bob Crittenden, former Senior Health Policy Advisor for Governor Inslee and Dorothy Teeter, Principal/Owner of Teeter Health Strategies, joined the Summit to give attendees an inside look into the history of incentives in health care. With many people asking “how did we get here” and “where do we go from here,” Teeter and Dr. Crittenden shared answers. 

 

 

  • While there is emphasis on economics when we discuss incentives, there are other kinds of incentives to consider, including moral and social incentives. However, when we think about what levers we can pull to make change, money matters. 
  • Employer-based insurance goes back to World War II when the government incented employer involvement in health care by offering tax deductions.
  • The changes we have seen throughout history, including the move to value, are structured on the backbone of a fee-for-service system that was established in the 60s and 70s – that is a huge problem.
  • Diagnosis Related Groups came into play in 1983. This is when the first equity constructs were introduced,  but the word equity was not used. 
  • We know that social determinants make a huge impact on health but haven’t figured out how to structure payment to address them. 
  • The Medicare Fee Schedule came into play in the 90s, leading to a discovery that if services are paid for individually, the best way to maximize income would be to provide more services. This contributed to uncontrollable costs. 
  • In 2004, it was becoming clear that fee-for-service system was not working, and Medicare began incentivizing better quality. 
  • The shifts that have worked in the past are the ones that have a common goal and require all parties to work toward that goal. That is true alignment. 

Watch the full discussion here: 

 

5 Points of Health Care™ Panel: Where Does the Money Go? A system-wide look at the current state of incentives in health care

Our 5 Points of Health Care panel took a system-wide look at the current state of incentives in health care, sharing their views on cashflow from each of their disparate perspectives. 

  • Moderator: Kim Prendergast –Director, Social Determinants of Health at Community Care Cooperative
  • Patient: Michael Mittelman, MBA, Sec+ – Cybersecurity Researcher/Patient Advocate 
  • Payer: Peter R. McClung – Vice President, Sales & Account Management, Regence BlueShield
  • Policymaker: Sophia Tripoli – Director, Healthcare Innovation, Families USA
  • Provider: Arlesia Bailey – Senior Director of Odessa Brown Children’s Clinic, Seattle Children’s Hospital 
  • Purchaser: Karen S. Johnson, PhD –Director, Performance Improvement, Washington Health Alliance

 

 

  • Patient: We need to remove profits and private equity from health care. As long as private equity and health care for-profit entities are making rules around who gets what, there is always going to be a problem with incentivizing health.
  • Payer: Connect data in an interoperable way to create actionable insights that help guide patients on their health care journeys.
  • Policymaker: We need to unleash prices to the public and share corresponding quality information so we can understand the underlying price of the health care services. 
  • Provider: Providers want to worry about patients having the best experience and best possible outcomes that they can contribute to. This goes back to the business of health care – it is not currently setup in a way to support that model. 
  • Purchaser: In tight labor markets (like greater Seattle), employers see their benefits packages as important employee retention and attraction tools. Therefore, they are reluctant to change those offerings and shift towards packages that incentive value. 

 

 

The Path Forward for Incentivizing Health 

“Dr. Couch and Dr. Mostashari distilled their experience into the most important learning point: short of mandating fees, we must work with providers in partnership to obtain value” – feedback from an anonymous attendee.

Dr. Marion Couch, SVP of Health Care Services at Cambia Health Solutions, and Dr. Mostashari, CEO of Aledade, forecasted methods to improve health outcomes capable of starting today. They looked at how we can progress past fee-for-service to deliver more equitable, higher quality, and lower cost care.

 

  • If you are innovator in the space, have faith that if you start a company health care regulation will continue to improve over time. 
  • If you are creating a sustainable business model for the next 20 years, make sure that the alignment among stakeholders is good for everyone at the table. 
  • The conversations around total cost of care must be coupled with improved value and quality. 
  • COVID showed the dysfunction of the payment model system. FFS practices were going out of business and laying people off in a time when people needed care the most. With the move to value, what we’re trying to say is you can keep your independence but be part of something bigger. 

 

 

To get at the heart of how each stakeholder is currently incentivized and possibilities for future transformation, attendees had the opportunity to join breakout sessions to ask pointed questions of the 5 Points of Health Care representatives. 

“The breakout sessions were unbelievable, the subject matter expertise and insights from experience and longevity in the field were unbelievable.  The whole summit had delightful conversation, vulnerable topics, honest and authentic discourse.” – Sarah Gallo PA-C, Summit attendee

Event partner Accountable Care Learning Collaborative also provided peer learning sessions pointing to real-world examples and data showcasing innovations made possible through aligned incentives. Overall, 81% of respondents shared that the Optimizing Incentives Summit improved their understanding of the need to align incentives in health care and that they intended to apply their learnings in their daily work.

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