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Transactions in Value-Based Care: Trends and Developments

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Andrea Ferrari, Principal and General Counsel, Pinnacle Healthcare Consulting, speaks with Michael Lemell, Director of Value-Based Care Contracting, AdventHealth, and Kristen McDermott Woodrum, Partner, McGuireWoods, about trends and developments pertaining to transactions in value-based care. They discuss the meaning of value-based care, the types of health care stakeholders that are currently participating in value-based care and how that is changing, recent examples of transactions in value-based care, and key trends to watch. Sponsored by Pinnacle.

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Speaker 1:

Support for A H L A comes from Pinnacle, which is a trusted advisor to a wide range of for-profit and not-for-profit healthcare organizations. Nationally, they leverage the resources of their six consulting divisions to provide superior services, such as compensation, valuation, and provider arrangements, transaction support services and valuation, value-based care, and cost reduction, compliance and revenue cycle services, enterprise risk and healthcare operations management support, and real estate consulting. Pinnacle has been a partner in the business of healthcare for the last 25 years. For more information, visit ask phc.com.

Speaker 2:

Welcome everyone to the podcast. We're gonna talk today about value-based care and transactions in value-based care. I'm joined today by Kristen McDermott, Woodrum and Michael Lamel . And we're going to , uh, have a sort of question and answer format , uh, for our session today. And I'm gonna start , uh, with the first question, which I'm gonna pose to both , uh, Michael and Kristen . And that is, will you tell listeners a little bit about yourself and your role and experience with value-based care? And I'm gonna start with , uh, Michael.

Speaker 3:

Perfect. And thank you so much, Andrea. Uh, greetings. Uh , my name is Michael Lamel . Uh, and I hold the position of Director of Value-based Care contracting at Advent Health . Uh, advent Health's nonprofit healthcare system , uh, headquartered in Florida, that operates facilities in nine states across the us . Uh, in my role , um, as , uh, director of Value-based Care contracting, I oversee contracting and negotiations with payers across various domains. Uh, in this role, I'm responsible for managing contracts within our clinically integrated networks , uh, employed medical group, primary care network , uh, bundle payment programs direct to employer efforts and clinics, catering to the 65 plus population , uh, with a legal background and an L l M and health law. Uh, coupled with, with my recent completion of an mba , I , I , I , I like to believe that I'm, that I bring a well-rounded skillset to my role. So , um, I say that jokingly, but certainly the , the topic of which we will be talking through today is one that I'm very passionate about, and I'm honored to have been invited by the h l A to share insights. So , once again , uh, thank you for the opportunity, Andrea .

Speaker 2:

Well, thank you so much for being here, Michael. Uh, Kristen , um, same question to you. Will you tell listeners a little bit about yourself and your role and experience with value-based Care?

Speaker 4:

Yes. Thank you, Andrea. I'm Kristen McDermott Woodrum , a partner in the Atlanta office of McGuire Woods. I focus on healthcare transactions and regulatory matters primarily for providers, including health systems, and have worked with value-based care over the years , um, with the range of providers including evaluating, entering into exiting, and participating in CMS, and seeing the my alternative payment models , um, all the ACOs, the ins and outs of participation, including overlapping participation in multiple models, the impact of the transaction on participation and requirements of the Quality Payment Program with <inaudible> and alternative payment model, advanced alternative payment model tracks . Um, I've worked with clients to stand up clinically integrated networks , uh, structuring around, you know , antitrust tax fraud and abuse issues , um, including governance documents, participation agreements, charters, and working with with folks like Mi Michael and the payer strategy. Um, I've helped clients create direct contracting arrangements for large employers , um, assist on bundled payment arrangements or episode based payment arrangements, which I really still take off , um, with a shift in more procedures to the outpatient setting, including total joint replacement. Um, and additionally , uh, have done a lot of joint ventures around those types of outpatient settings. Um, I've worked in investment in hospital at home, another tech-enabled care delivery, which has really transformed how healthcare is delivered and reimbursed and helped clients evaluate and invest in tech-enabled solutions of virtual care. Have a little more limited experience on the plan side with TPAs and plans focused on integrated provider plans. Um, and I've worked with private equity investors in this area. They see a lot of opportunity in value-based care , um, and finally a little bit of work with a large employer coalition on its attempts to be a more active purchaser of higher quality, affordable care.

Speaker 2:

So you both have a lot of really interesting experience , uh, to bring to this conversation, and I'm really excited to have you both , uh, here today. Um, I we're , we said, we were talking about value-based care, and , uh, I really think that there are various notions of what this term means. So , uh, to sort of level set and, and let listeners know what we're, what we're focusing on today. Um, can you each give , um, from your perspective, a a definition for the term value-based care, what value-based care means? And I'm gonna start with , uh, Michael again .

Speaker 3:

Uh , thank you Andrea and I, I certainly appreciate us starting off with this question because I've, I've been to numerous conferences and a bunch of meetings, and there certainly are different iterations of what value-based care is , uh, from my perspective as, as you questioned it. Uh, value-based care is, is a healthcare model that's all about giving top-notch care, cutting costs, and making sure patients get better. Uh, instead of just focusing on how many people they see, it puts the spotlight on quality and effectiveness. Uh, they really push for things like taking preventative measures, putting the patient at the center of everything and utilizing and , uh, practices that are backed up by evidence. Right? Uh, so the goal in my mind, and what we're doing here is to make sure patients have a great experience , uh, improve the overall health of the population, and save money by being efficient than working together. You know, they , they also want to measure outcomes, right? So make sure payments are tied to good quality and encourage collaboration between healthcare providers alike. Um, at the end of the day, basically, value-based care is all about using resources wisely to get the best outcomes for patients.

Speaker 2:

And, and Kristen , um, do you want to weigh in on what, from your perspective, the term value-based care means?

Speaker 4:

I, I think I'm gonna adopt Michael's definition going forward. Um, that was well articulated on the <laugh> on note that , um, you know , we hear a lot about value-based care, but it's mainly in the context of how the care is reimbursed. So the focus is really on value-based payment rather than value-based care delivery. Um, and increasingly, I'm hearing people talk about capitation being the end goal of value-based care , um, you know, being a model where providers are paid based on outcomes, but really, as Michael said, the central components are quality and health outcomes and the cost of care. Um, you know, while we have an enormous healthcare spend in the United States, we still have poor health outcomes, which affects everyone. And so, you know, some of the academics, Michael Porter at Harvard and others have articulated that value equals health outcomes that matter to patients divided by the cost of delivering the outcomes. So in that context, value is the goal that can unite the interest of all the system participants as the solution to reduce the burden of healthcare , um, on the government and as stakeholders and have a healthier, healthier population. But the big question has always been how to design a healthcare delivery system that substantially improves patient value. And then at the macro level , how to shift competition to competing on value. And I would also add that , um, you know , looking at different care delivery models that achieve the goal , the goal of value, I would cast the net wide to encompass care coordination, developing a care team, developing and adhering to clinical pathways, approving care protocols , um, utilizing advanced practice providers at the top of their license , the net care team, shifting the site of service to a lower cost setting and transforming how care is delivered entirely. Um, and for that, I think acute hospital care at home is a great, great example just in sort of the means of delivering value-based care.

Speaker 2:

So, so Kristen , you mentioned , uh, casting the net wide and, and including many different types of providers in value-based care. Um, that's sort of a good segue into , uh, my next question, which is, who and what types of healthcare stakeholders do you see currently participating in value-based care? And is that changing or do you foresee it changing , uh, in the near future?

Speaker 4:

Um, yeah, that's a great question, Andrea. And I think that it's , um, variable across the country. In some markets, we have greater penetration of value-based care and in certain kind of segments of the market. I mean , we've certainly come a long way since the Affordable Care Act was enacted for the past over 10 years. Cmm I , the Center for Medicare and Medicaid Innovation has been working to transition the entire healthcare system to value-based care by testing and evaluating new payment and service delivery models. Um , and if you look at the CMM I map where innovation is happening, it shows it all across the country. You know , they've tested over 50 models , um, although only six have generated statistically significant savings and only format their requirements , um, articulated for C M I to expand a program. Um, but they're looking to refresh their strategy and have all traditional Medicare beneficiaries and a vast majority of Medicaid beneficiaries in their relationship with accountability for quality and total cost of care by 2030 . Um, you know, similarly, the CMS Quality Payment Program created by macros highest more Medicare payments to performance and encourages participation in alternative payment models. Um, and I think it's a range as a healthcare , um, payment learning and action network has established a framework. Uh , we often look to, for the transition to value based care. So four categories. There are fee for service , just flat fee for service , no quality or value link to category two, which is fee for service with a link to quality and value, pay for reporting, pay for performance, moving to alternative payment models with shared savings or both upside and downside risk. And then finally, you know , that true population based payment. And so, you know, we may have a lot of the pop , a lot of the providers across the country on level two, where they're, you know , pay for reporting , um, pay for some sort of quality metrics, you know, in terms of shifting people to upset and downside risk. You know, we haven't quite gotten there yet. Um, but in some pockets we're seeing a lot of that. I work with a lot of orthopedic groups that are successfully participating in bundled payment programs, you know, episode-based care. Um, the accountable care programs are, you know, thriving. We currently have , um, I think 450 MSPs with close to 11 million assigned beneficiaries, and thanks to the MSSP Pathways to Success rule , um, which was intended to promote a quicker transition to that two-sided risk. Currently 67% of those MSSP ACOs, RM two-sided risk payments. Um, we also see commercial ACOs and value based payer contracts with clinically integrated networks. You know , there's a varying degree of risk bearing there. I think the trend is really to start small with some quality metrics and upside maybe , uh, per member per month care for coordination payment . Um , and then I think we're seeing a shift towards accepting risk with value-based enabled company , value-based enablement companies , um, the AC reach program where we've seen a lot of private investment, and then again, on the kind of private side, the Medicare advantage, which is, you know, capitated , um, payment to the plan. And increasingly we're seeing interest in providers downstream of Medicare Advantage or other sort of risk-bearing entities, capturing a portion of the savings by delivering delivering care , um, with some downside risk. Uh , and in certain specialties, I think nephrology, I mentioned orthopedics, we're seeing a ton of value-based care , um, moving that way potentially in specialties like oncology and cardiology. Um, and then on the primary care side, you know , that's central to those population-based and accountable care models. There's been a lot of outside corporate investment in , um, primary care and the acceptance of capitated risk for that population.

Speaker 2:

So , so it seems like the, the universe of participants of value-based care is, is really expanding. I think , uh, years ago it really was , um, something that was focused primarily on primary care physicians. Um, but you've certainly mentioned a lot of specialists who are very active in this space now. Um, and I think we're starting to see , um, other types of stakeholders become very active in the value-based care space as well. Um, you mentioned hospitals and , um, and , uh, post-acute providers and investors and private equity and so on. Um, Michael , um, I , I wanna , uh, pose the same , uh, question to you. Who or what types of healthcare stakeholders do you see currently participating in value-based care from your perspective? And do you foresee that changing?

Speaker 3:

Yes. Um, listening to, to Kristen's answer and, and, and your additional comments there, Andrea, at the end, I , I think you, you both captured extremely well , uh, what, what I'm seeing as well. Um, for the most part, PCPs are the main participants in many of these types of models. As you know, most quality metrics and utilization gaps are primary care focused . Um, as for specialists, programs are being deployed , uh, within the last few years , um, around specific diseases and conditions. As Kristen stated , uh, what I'm seeing there specifically are , uh, programs around C K D or chronic kidney disease at E S R D, you know, end stage renal disease. Uh, so programs that focus there. And then from a private equity perspective, firms are increasingly investing in healthcare organizations involved in value-based care. They provide financial resources and strategic support , uh, both from an operational perspective as well as through , uh, existing payer relationships. They , they have these pre-established relationships with payers, and they're bringing it to the table, partnering with, with physicians and such , uh, essentially to promote , you know, the development and expansion of value-based care models , uh, aiming to improve patient outcomes and achieve , uh, sustainable financial performance. Uh, so very much aligned with, with both of your responses. Um, and, and what I'm seeing is exactly this, you know, a a lot more attention and inclusion of specialists in this, in this space. And of course, you know, as Kristen mentioned , uh, enablers, right? This is something that, from my perspective is, is fairly new, but we're seeing more enablers , uh, uh, participate in and , and putting some skin in the game when it comes to downside risk contracts.

Speaker 2:

So one of the things that we wanted to focus on in this podcast , um, was , uh, trends with respect to transactions in value-based care. Um, and I'm gonna start , uh, with a question to Michael , um, about transactions. So from your perspective, what are some of the notable recent examples of , uh, transactions in the value-based care space?

Speaker 3:

Um, so, so as I think of , uh, your question, I have , uh, two, two thoughts that come to mind. I'll start off by randomly saying two words , uh, vertical integration, right? Um , number one, the first example that comes to mind is , um, it's , it's about five years old back in 2018, when, when health insurance , uh, Cigna completed its acquisition of Pharmacy Benefit Manager Express Scripts. Uh, this transaction was significant , uh, because it brought together a health insurer and a pharmacy benefit manager under one single umbrella, one entity , uh, which allows for greater integration and coordination of health healthcare services by combining, you know, their care , their capabilities , uh, sig non Express Scripts aim to enhance medication management and improve health outcomes for, for those patients, while reducing costs through different , uh, value-based initiatives. But then number two, you think of C V S Health, right? Uh, around the same time, I think it was also in 2018, D V S Health acquired Aetna, which then later acquired Signify Health , which is a technology-based platform , uh, that provides analytics among other technology support, as well as a major ma , a major presence in , uh, home healthcare , uh, followed by their most recent acquisition of Oak Street Health. You know, so with the acquisition of Signify Health , I believe , um, that acquisition brought forth a little bit over a thousand providers across all 50 states. And now with the acquisition of Oak Street Health, they picked up 169 medical centers, which I don't know exactly what the count of providers is, but certainly very significant in size across most of the United States. I believe it was 29 or 30 states. Uh , so, you know, that's last example for me, certainly is something that's , uh, a notable example of , uh, of a value-based care transaction, specifically because it solidifies , uh, their efforts to implement value-based , uh, payment ecosystems across the board.

Speaker 4:

Yeah, I agree with Michael. Those are fantastic examples of , um, value-based transactions, and definitely keep an eye on the vertical integration. Um, look at those payers, look at the providers. I would add Optum is poised right now to acquire a medicist , which is a home care provider that also owns essa , which is a big hospital, advanced care at home player . And so I would consider that to be sort of a value-based strategy , um, you know, driving that transaction , um, and the dollars on the transactions that Michael described, they're huge. And there's, you know, there's embedding wars including for signify health . Um, so there's a ton of interest here. And the value in kinda controlling these assets and services is, you know, clear , um, you know, Walgreens, village d , Amazon one, medical, other examples of , um, you know, value-based investments. Um, and then I would say on the hospital side, kind of moving away from all these corporate disruptors and , um, kind of the payers , uh, I think it's very interesting to see that Kaiser , uh, is planning to launch new nonprofit Rise Health . Um, they announced in May that they would acquire Geisinger Health and expand through acquisitions of health systems focused on value-based care. And so that's, you know , two very old , very experienced health systems , um, that have focused on value-based care , um, coming together, the full financial terms to that deal weren't disclosed, but Kaiser did indicate that it plans to invest 5 billion in rise over the next five years or so, and acquire five or six health systems to get to total revenues of 30 to 35 billion . And their goals are to expand and accelerate the adoption of value-based care , um, and diverse multi-payer, multi provider community health system environments , um, all value-based purposes that they've articulated , um, in line with the definitions we, we started with . Um, and I think that's great. I think Geisinger is known for proven care, and they have the pioneering approach to care redesign a guarantee on certain procedures, lifetime warranty on joint replacements. You know, Kaiser has , um, its health plans as well as its provider focused through its hospitals and Permanente group . Um, and so there's a lot of opportunity there for , um, interesting , um, care redelivery and , and reimbursement, and I think it might include hospital at home is a large component. That program was expanded for two more years under fee for service medic Medicare. Um, and I think a lot of it's expected that it'll stay in some form, and certainly for some payers, it makes a ton of sense to , um, you know, looking forward perhaps have a , a lower reimbursement rate for an inpatient stay that occurs at a patient's home. Um, you know, patient satisfaction, just looking at some of the numbers there, especially with Kaiser's medically home group , um, that they own with Mayo , you know, are off the charts, people like being at home, there's , you know, no hospital acquired infections and those circumstances. So I , I would keep an eye on that just in terms of a nonprofit sort of hospital focused value based care transaction.

Speaker 2:

So Kristen , it sounds like you were , um, identifying some, some trends there that are , um, I think indicative of sort of where we're going with value-based care. And , and I'm gonna ask Michael, I think , um, what trends , uh, do you think listeners should be aware of for planning value-based care and related transactions , um, as the market's evolving?

Speaker 3:

Yeah, certainly. Um, so, so a few thoughts here. Um, for the most part, they're related to value-based care contracting, which is, as I stated earlier, is , uh, specifically my, my concentration and focus. But I , I feel like, you know, listeners planning value-based care transactions , uh, should be aware of at least these three key trends that, that I've been seeing for the last , uh, few years. For firstly , uh, the shift towards population health management is a crucial trend to consider , um, as healthcare providers increasingly focus on managing the health of a defiant population rather than merely treating in individual patients , uh, value-based care models are becoming more prevalent. Obviously, as we've been , uh, discussing here , uh, listeners should understand that principles of population health management and how it could be integrated into their contracting strategies. Um, additionally , um, as healthcare continues to evolve, so do the payment models associated with value-based care. So alternative payment models such as ACOs and bundle payments, as Kristen referenced earlier, are gaining traction, a lot of traction as a matter of fact , um, as a means to incentivize better outcomes and reduce costs. So staying up to date with the latest payment models and their are contractual implications is, is essential , uh, for a successful value-based care contracting. And then lastly, you know, and certainly not , uh, least important regulatory changes in policy developments at both the federal and state levels could greatly influence value-based care arrangements and contracting. So listeners , uh, must stay informed about regulatory policy changes related to updates to reimbursement models , uh, modifications to quality metrics , which is something that, that I often see across our, our , our numerous contracts , um, and revisions to anti-kickback statutes, right? You know, these changes could impact the structure and implementation of value-based , uh, care transactions. And it's essential to understand the evolving regulatory landscape.

Speaker 2:

I , I think that's a , that's a key point. Um, and, and maybe I'll ask , uh, Kristen , um, a little bit about , um, the legal issues , uh, that are affecting , uh, the evolution of value-based care transactions. Um, Kristen , are there , uh, specific stumbling blocks or developments that you think listeners should be aware of , uh, for planning value-based care transactions going forward? Things that , that maybe they should be focusing on?

Speaker 4:

Yeah, I'll echo what Michael said is, you know, stay tuned. The rules are always changing. Um, you know, one example , um, to be reimbursed while under value based models that CMMI is running, you have to focus on health equity , um, and social determinants of health . That's a new , um, you know , broad focus of a lot of the new models we're seeing. I would also focus on, on some of the rules related to risk adjustment. Um, you know, Medicare Advantage is getting a lot of attention now. It provides coverage to over half of all Medicare beneficiaries. Um, and it's just growing. And we've recently seen some tightening of the rules on the risk adjustment. Um, you know , in ma for each beneficiary, the company receives a capitated payment that is the predicted cost of care, but it's adjusted , um, you know, for beneficiaries who might have higher expected health costs based on how status , um, or other factors. So , um, there's been a lot of fraud and abuse focus on risk adjustment and also just the tightening of the rules and a new risk adjustment data validation role . Um, and so that's, that's one aspect, fraud and abuse in general is, you know, always, always something to keep an eye on. And , um, in these arrangements, it takes a lot of resources and investment , um, and requires new relationships. And so that can create kind of opportunities and also sort of challenges if , you know, if you're trying to fund some of the , um, value based activities, you know , you still have to follow , um, the requirements of, of the threaten abuse law start kickback and, you know, also the , um, beneficiary inducement , um, components of the civil monetary penalty of law . So, you know, giving patients incentives to , um, kinda enhance their care or adhere to care or, you know , have the opportunity to have access to care. Um, you know, all of that has to be structured to , to comply with the fraud abuse laws , and that's possible. Um, you know, traditionally our laws have meant to segregate different players in the healthcare , um, ecosystem and, you know , keep , keep everything arms length to disincentivize over utilization and sort of the incentives of the fee for service system . Um, and it turned on its head when we talked value based care. Um, and so, you know, looking at the exceptions through a new lens, perhaps taking advantage of some of the flexibilities and the regulatory spread rules , including the shark and kickback rules , um, that came out in late 2020. Um , money , I've seen a lot of people structuring value-based enterprises , um, to try to take advantage of flexibilities there. Um, other laws include , you know , data sharing, kinda hipaa, you have to have data to make any sort of value-based arrangement work. And sharing that data has to , uh, you know, comply with the data privacy and security laws often under Hippo will establish an organized healthcare arrangement to enable some of that data sharing in the right circumstances. Um, you know, tax antitrust has to be considered in setting these things up as well as insurance laws . Anytime you're bearing insurance risk , you know, there's potentially a requirement to register with the state as a risk bearing organization or , um, you know, some other type of license , uh, for insurance or TPA administration type services . Andrea ,

Speaker 3:

I was , was gonna jump , I was jump I don't interrupt you Kristen , cuz you said it so well, but you, you certainly stole the words outta my mouth , uh, related to, to data , um, you know, I I I, I, I'm stealing this catchphrase from a conference I attended a few weeks ago. Uh, no data, no deal, right? So , um, I, I was in Miami a few weeks ago attending a , a value-based care summit, and I've been preaching this , uh, a , a similar message , uh, through some of my , uh, most recent LinkedIn posts , uh, payer's unwillingness to share key data sets such as, you know, paid claims versus build claims. Something as simple as that is an issue that we often see and struggle with. So, you know, the inability to receive actionable data prohibits one's ability to properly manage your attributed , uh, uh, population. And by default, it impacts your, your quality and your utilization performance. So that's what I would say, Andrea, is, is the stumbling block that we often experience from a , a value-based care contracting perspective, but certainly , uh, very much aligned with what Kristen said.

Speaker 4:

Yeah , and to add to that, Michael, I know you deal with the technicalities of the contracts, but I would, you know, caution people not just to sign something based on discussions, the doubles and the details. And you know, it's very important to make sure that all the assumptions have been verified and that the value-based contract says what you think it says. And if there are assumptions about resources that are available , um, you know , that needs to be baked in and documented. You know , anytime you're accepting downside risk, you know , you need to know what you're signing.

Speaker 3:

Agreed, agreed. And if you have the opportunity to add on to , to, to your last comments there, Kristen , if you have the opportunity to fe and receive , you know, the , the , the data that's, that's being mentioned or highlighted within the agreement or any other , uh, any other items within the agreement beforehand, before even executing the agreement, that's certainly something that, that would be advantageous. Um, I , I , I've experienced something most recently where, you know, we've , uh, executed on a quality program only to find out that the types of reports that , um, we should be receiving are not what we expect it to receive. So certainly addressing that beforehand is , is key.

Speaker 2:

So , so Michael and Kristen , I think you've both given some , um, really , uh, significant , um, examples and food for thought for listeners. Um, as we wrap things up, I'm gonna ask you both of the same question. Is there anything else that you think listeners should know or consider in regard to value-based care in the current environment? Something that you haven't talked about yet , uh, but you wanna leave listeners with , um, as, as parting words? Um, I'm gonna start with Michael.

Speaker 3:

Yeah, yeah, I have a few, a few thoughts here. Um, one of one I've already touched on, which is, you know , uh, data access to data and such. Uh, so I'll touch on some of the other things that come to mind. So , uh, importance of cultural change, and this is something that I think would be more applicable for those listeners that are now , uh, entering the value-based space , um, or considering to enter the value-based care space and are still in that, you know , uh, entry level if, if you will, of, of this, this , uh, area which is implementing value-based care requires a , a shift in mindsets and culture across the healthcare ecosystem. Um, it , it involves moving, as we stated, from a fee-for-service approach to one that prioritizes collaboration , uh, care coordination and patient outcomes . So, you know, it , it's important to understand , uh, what, what we've said here. Um, it's important to understand that it is, it is a journey. Um, and , um, yeah, I'll , I'll leave it at that. Uh, the second is , uh, collaboration and care coordination, which I think Kristen touched on , uh, at a certain point , uh, earlier. Uh, the col collaboration among healthcare providers , uh, payers and other key stakeholders is key , uh, to successful value-based care. So listeners should foster relationships and establish effective communication channels to promote care coordination , uh, share best practices and address gaps in care. Uh, collaborative efforts could lead to, to better patient outcomes , uh, reduced duplicative services and improve resource utilization. Uh , so ultimately, you know, achieving the goals of value-based care requires a , a comprehensive approach that considers the legal, regulatory, cultural and op operational aspects of healthcare delivery , uh, by staying informed, as we've been saying throughout this , um, this podcast , uh, collaborating with stakeholders and prioritizing pa patient-centric care listeners could navigate the current environment and drive positive changes in healthcare through value-based care.

Speaker 2:

Thanks so much, Michael. Uh , Kristen , you wanna to weigh in , um, with , um, some final thoughts and, and then let us know if there's anything that you think listeners should , um, know or considering regard to value-based care in the current environment, something you haven't already mentioned.

Speaker 4:

Sure. I feel like for years now, value-based care has been sort of a buzzword and, you know, we, we hear about it, but it's not something to take immediate action on. Um, but I think that's changing the momentum is really moving towards more value-based care in the government programs and commercial as well. Um, so I think, you know, it's time to kind of look around and, and look forward and see what , um, what your strategy might be in the next few years, and also look around you in your market and see, you know, it's changing with all of these disruptors. Um, sort of the referral patterns may be different and, you know, figure out what the , the new future looks like. I think one trend that , um, you know, we've seen for years is like neutrality, and that is very consistent with value-based care. And so kinda , you know, considering investments in outpatient services versus, versus inpatient or in home care or in virtual care , um, you know, obviously that's picked up a lot of momentum. Um, so, you know, predict that that will continue. Um, I think that from a , um, operational standpoint, as Michael said, you need a lot more communication and collaboration in value-based arrangements. You know, a lot of hospitals and other providers operate in silos. Um, but if you've got a value-based arrangement, you need to have communication between your managed care team that structuring value-based payment contract between your quality team , um, and between physician contracting, you know, just as an example of three. And , um, you're gonna need buy-in from all of the stakeholders , um, and that includes your physicians . And so I've seen multiple different studies about physician compensation and you know, right now it seems like , uh, we're still largely in the work RVU productivity model of physician comp , um, but we're seeing that shift and , um, seeing a little bit more of the physician comp tied to performance metrics and outcomes. Um, also I think just the resources required for value-based care are pretty enormous and a lot of systems have been investing in healthcare IT EHRs , um, but it also involves sort of clinical decision support care pathways and additional staffing care coordinators , um, and just different types of staffing and so that, that takes a while to implement. And then finally, I think just on the regulatory front, we have seen , um, a lot of loosening of regulations. HHS implemented its regulatory sprint towards coordinated care was the goal of using some of the restrictions that might have been impeding the shift towards body-based care. And , um, so that I think is a great trend. It's a lot to work out. You can't just say I'm doing something with a value-based purpose and get a free pass. Rather, you have , um, you know, options to rely on some of the old safe harbors and exceptions that are the fine abuse love , or you have new opportunities which are exciting , um, under the, the new value-based rules and some of the related exceptions in safe harbors that were put out outcomes and patient engagement and safe , um, support. But it requires work and a lot more oversight than we're used to with some of the traditional , um, exceptions. And I guess I'll leave , I'll leave it on, you know, value-based care is not one size fits all . There are a lot of opportunities out there to take, you know , take it in different forms and in different degrees. Um, and so, you know , start somewhere be creative and, you know, typically it's a challenge and it requires a different way of thinking, but it's a lot of fun to try to structure a value based arrangement that will not only be effective, but be compliant.

Speaker 2:

Well , thanks so much Kristen and Michael. Um, thank you for being here today. I think we had a great conversation. Um, and , um, hopefully listeners , um, can , uh, reach out to both of you if they have some additional questions. Um, if you wanna provide your contact information , uh, feel free to to do that. Uh , now I think , um, it , it might be helpful for listeners to have that contact information. Um , Michael or Kristen , do you wanna share?

Speaker 3:

Yeah, of course. Certainly. Um, from my end , um, I could be reached , uh, via email at Michael, m i c h a e l , Lamel , L e m e l , at advent health.com . That's a dv E n t h e l t h.com . Um, and , uh, I would definitely look forward to receiving any communication and opportunities to engage with, with this au with this audience.

Speaker 4:

And you can find me on LinkedIn or on the McGuire Woods website. Um, my email is kay woodrum McGuire woods.com . And you know, feel free to gimme a call. My, my number's on the site and I love talking about this, so don't be shy.

Speaker 1:

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