InHealth Advisors is pleased to bring you a monthly summary of the latest thought leadership, news, and transaction activity in value-based care (VBC). To assist busy healthcare executives in following VBC developments in a time-efficient fashion, we have assembled brief descriptions of and links to a curated list of the most insightful developments in VBC and provider alignment.
This edition summarizes the continued evolution of value-based care. Our Thought Leadership returns to AI with groundbreaking funding, solutions, and integrations. We explore advancements in addressing social determinants of health, major Provider Initiatives from c-suite health systems, Payor Updates highlighting new digital health partnerships, and Transaction Activity involving physician practices acquired by Amazon and private equity.
This newsletter has previously covered innovations in addressing health-related social risks. This outstanding piece from HFMA profiles the efforts of health system and community organization partnerships in tackling homelessness. The profiles highlight the underlying characteristics of successful partnerships including: (1) real-time data sharing between health systems and community organizations that address homelessness, (2) care coordination meetings between clinical staff and community health workers to secure housing (even if temporary) after acute care episodes, and (3) using clinical outreach teams (e.g., for vaccinations in homeless shelters) to serve as conduits for connection to community resources providers. These programs offer a rare opportunity to meaningfully reduce costs while improving health for at-risk populations.
As the prevalence of value-based reimbursement models increase, the need for health system leadership focused on success in value-based care rises. This piece interviews a number of healthcare leaders who have prioritized value-based care as a strategy for their health system. The various viewpoints discuss the emerging need due to pressure on reimbursement rates and market entry by new delivery providers including digital health and artificial intelligence solutions. The interviewees span health systems located in varying markets from dense metropolises to rural communities, representing the broad and growing importance of value-based care to health system strategy. Of note is the increasingly central role of effective coordination between patients, payors, and providers for success in value-based care, with recognition of the monetary and time costs necessary to make this coordination a reality.
Read More from Becker’s Healthcare
As implied by the article title, not all organizations view the expansion of VBC reimbursement models as an opportunity. This piece explores comments to investors by leadership at Tenet Healthcare regarding the potential negative impact of “value-based purchasing and alternative payment models.” Tenet flagged the combination of Medicare readmission penalties and mandatory bundled payment models as threats to future revenue. They also noted that commercial payors are increasingly leaning into VBC reimbursement models, specifically citing claims denials related to preventable adverse events. These comments underscore the importance of developing strategies to transition to VBC delivery models as the shifting sands of healthcare reimbursement migrate to risk-based payment structures.
Read More from Becker’s Healthcare
The Healthcare Information and Management Systems Society (HIMSS) recently held their annual conference, with generative AI taking center stage. This article provides an efficiently concise summary of the major developments from the conference, including some that impact VBC. Innovaccer demoed its AI-integrated tablet, which is designed to address care and coding gaps, assist in clinical documentation, and facilitate diagnoses—all at the patient point of care; it also announced its acquisition of Pharmacy Quality Solutions, a technology platform that enables VBC by connecting payors to high-value pharmacies. Microsoft announced its deployment of Nuance’s Dax Copilot (an AI solution to assist clinical documentation) at Stanford Medicine, WellSpan Health, and Providence. There are many more developments worth exploring in the article.
Read More from digitalhealthwire
Healthcare providers regularly report fatigue associated with a cornucopia of uncoordinated digital health solutions. A growing strategy employed by health systems involves developing a fully-integrated digital experience from the hospital to the home. This may have motivated General Catalyst’s contemplated acquisition of Summa Health. This article explores the approach taken by Mayo Clinic with their new hospital campus in enhancing the patient experience with digital tools. From ambient AI listening for documenting clinical notes to predesignated parking to customized music and lighting preferences for patients, Mayo representatives describe their philosophy regarding the design of next-generation healthcare facilities.
Read More from Becker’s Healthcare
In a growing trend among digital health providers, payors are engaging solutions that are developed for managing the health of targeted subpopulations. This story discusses a chronic care management solution for veterans developed by DUOS and integrated with Humana’s Medicare Advantage health plan in Louisiana. The program facilitates care coordination and seeks to improve outcomes and treatment adherence, while reducing no-show rates. With a wider shakedown in the digital health industry, new partnerships between payors and digital health firms provide a glimpse into how digital care models are evolving.
Read More from Fierce Healthcare
Spending on post-acute / long-term care services comprise around 15% of Medicare’s total annual budget. Various stakeholders have focused on this segment of the healthcare market as a key area for improvement in costs and outcomes through enhanced care coordination. This piece explores partnership pathways between post-acute / long-term care providers and accountable care organizations. In particular, it discusses recommendations around increasing skilled nursing facility (SNF) participation in Medicare shared savings and value-based care programs. Strategies include revising patient attribution formulas, adjusting reimbursement to SNFs based on risk scoring, development of SNF-specific quality measures, and enhanced data reporting by Medicare on SNF utilization and costs. Integration with ACOs can provide SNFs a pathway for generating sustainable revenues in unfavorable market conditions.
Read More from Fierce Healthcare
Patsy Newitt from Becker’s breaks down the major moves Amazon has made in acquiring primary care providers (e.g., One Medical) and developing partnerships for specialty care with health systems. As with other large corporate entities, such as Walmart, the partnerships with health systems for specialty referrals further VBC goals by directing patients in need of acute care to efficient providers of such services. It remains to be seen how scalable this approach may be given that many health systems operate significant primary care service lines themselves, making One Medical a direct competitor. However, if care coordination between primary care and specialty providers can succeed in bending the cost curve and delivering better quality care, both parties stand to gain through gainsharing and quality bonus opportunities from payors.
Read More from Becker’s Healthcare
Ms. Newitt strikes again with this quick overview of the key data points related to private equity ownership of physician practices. The 600% growth rate cited in the headline pertains to the period from 2012 to 2021, representing an annual growth rate of nearly 25%. Primary specialties targeted for acquisition include cardiology, dermatology, gastroenterology, OB/GYN, oncology, ophthalmology, orthopedics, primary care, radiology, and urology. Over the time period, dermatology, ophthalmology, and gastroenterology represented the lion’s share of acquisitions. A major chunk of these transactions occurred in 2021, perhaps making up for lulls during the early stage of the COVID-19 pandemic. The greatest proportion of activity occurred in states in the Southern US.
Read More from Becker’s Healthcare
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