There Is Only One Way…Forward

By Bert Miuccio

A few weeks ago the House passed an untenable Affordable Health Care Act (AHCA) plan on to the Senate. Now the Administration and GOP leaders are hurriedly re-crafting the bill with hope of a scheduling Senate vote on it in July – so they can move forward with the rest of the GOP administration’s agenda. Today we still don’t know what the replacement to the Affordable Care Act (ACA) will actually be and how long the process of enacting it will take. We will not know even what its impact will be on Americans, medical practices, delivery networks, or on Medicare, Medicaid and commercial insurance carriers.

In the meantime, we at HealthTeamWorks^® remain laser focused on the essential work of supporting transformation in medical practices and provider networks by delivering performance evaluation and improvement solutions.

We are supporting nearly 3,000 primary care practices in fourteen regions across the United States via HealthTeamWorks’^® national role in CPC+ which focuses on the following.

The other federally-funded practice transformation pilot programs through which HealthTeamWorks^® provides support – State Innovation Model (SIM) programs in Colorado and Delaware, EvidenceNow Southwest (ENSW), Transforming Clinical Practice (TCPi) – as well as many other client engagements for practice transformation solutions, all focus on many of the same or related essential key drivers.

To meet the needs of value-based care delivery and regional health accountability, integration has become essential. Whether providers and practices are employed by a health system, are members of an Independent Physician Organization (PHO) – such as an IPA, Integrated Delivery Network (IDN), Clinically Integrated Network (CIN), or an Accountable Care Organization (ACO) – high performance across the network creates value for patients and optimizes sustainability in alternative payment models (APMs).

HealthTeamWorks^® recognizes the significant and important investment in moving away from volume toward a truly value-based delivery system. Regardless of your end goal as a network on the volume-value continuum, a comprehensive view of current state and the path forward creates a significant advantage in strategic planning and implementation.

Thus, in addition to working with medical practices, HealthTeamWorks^® also teams with Integrated Delivery Networks to provide solutions that focus on performance improvement at both the practice and the network level, including:

Assessment & Discovery – HealthTeamWorks^® looks at current contracting and payment models, practice level and population health performance compared with the network’s desired future state, e.g. optimized pay for performance, gains sharing (upside and/or downside risk), or population-based payment. Analysis of findings inform strategic planning, integrated service needs, and solutions mapping with the network to support transition to value-based delivery.

Payer Contracting – A review of payer contracts informs process and outcome measure alignment, prioritization of performance initiatives, and enhanced strategic use of practice revenue.

Network Leadership, Organizational Investment and Communication – HealthTeamWorks^® leaders work with system and network-level teams and clinicians to establish working and action groups, learning communities, and effective communication. We also connects clients with other similar groups and networks to share best practices, case studies, and varied approaches.

Data, Measure Alignment and Quality Improvement / Performance Improvement Strategies – While data has become more available to clinicians, practices, and systems in recent years, sorting through disparate data sources and reports, and juggling multiple measures and competing priorities proves challenging.  HealthTeamWorks^® works alongside networks to prioritize and align measures and improvement efforts to manage change fatigue and achieve optimal outcomes.

Care Integration – When does it make sense to integrate services, form narrow networks that guide referral patterns, or to establish collaborative care agreements?  What community-based organizations are needed to address the barriers and challenges patients and families are facing? As practices and delivery networks move toward shared accountability and payment, it becomes ever-more necessary to establish close working relationships with services across the community and region. As part of network formation, mechanisms must exist to evaluate care delivery and services. HealthTeamWorks^® helps clients develop and implement plans to address the comprehensive needs of an empaneled patient population.

Integrated, coordinated delivery of care across a provider network is not an overnight shift in culture, processes, or infrastructure.  High functioning networks actively engage patients, align services and resources based on the needs of a risk-stratified population, coordinate care across settings, optimize HIT, integrate services such as behavioral health, and have embedded continuous improvement processes in place to drive sustainable change. Knowing infrastructure investments are necessary to support value-based delivery, HealthTeamWorks^® works with clients to design and implement workflows that optimize patient care and financial performance across payment models.

HealthTeamWorks^® offers flexible options for networks to engage in a comprehensive evaluation of current performance that informs strategic planning and pacing toward value-based delivery.  Comprehensive or targeted service options are also available, and are generally informed by teaming with the client during the discovery process. Contract scope may include a combination of targeted services based on assessment of need at the practice and network level, and always include mutually agreed upon metrics of success.

If you would like to learn more about HealthTeamWorks^® transformation and performance improvement solutions for medical practices and integrated delivery networks, please contact me at bmiuccio@healthteamworks.org.