At the third annual U.S. News Hospital of Tomorrow forum, a case study looked at the journey from fee-for-service to fee-for-value pay, and explained how health care systems can use tools built through analytics to adapt to new reimbursement models, with improved health care as a result.
Speakers were Gregory Kile, senior vice president of insurance and payer strategies at Lehigh Valley Health Network, in eastern Pennsylvania, and president and CEO of Populytics; and Allison Yudt, director of value-based contracting at Populytics, an advanced analytics firm.
Both Kile and Yudt explained the importance of using predictive analytics to identify high-risk patient populations. Doing so informs strategies to coordinate and manage care for these patients, they said, and leads to payment innovations.
Kile cited LVHN’s employee health plan as proof of concept of how well analytic tools work to create savings centered on clinical initiatives. “We’re not looking at the rearview mirror, we’re actually hitting targets,” he said. In the first year, he said, the goal was $3.1 million in savings, and his group “hit it out of the park.”
Data tools include clinical pathway analytics. Yudt gave the example of a patient with breast cancer, and briefly displayed the clinical-oncology dashboard, one of several which partner organizations to consider treatment decisions. Clinical partners take the lead in developing treatment guidelines, she said.
Yudt described quality measures used in value-based contracts, and how large numbers of measures can be complicated and cumbersome for providers. Measures may not be consistent across payer contracts, she noted.
Populytics is working to align quality and utilization measures, Yudt said. While it offers physician incentives aimed to improve performance, a simple, one-page report allows doctors to compare their performance with those of their peers.
On its end, Populytics hands off information gleaned by analytic tools to the health care team. And LVHN deploys resources to health care providers, with higher-level resources depending on patients’ level of risk.
Chronically ill patients with conditions like congestive heart failure need more health management, and they benefit from a community care team. Teamwork is key, presenters said. Together, social workers, pharmacists, behavioral health specialists and care managers for the chronically ill help streamline and improve quality of patient care.
During the session, a video featured a heart failure patient, with a nurse care manager calling her home to check on her – making sure her weight wasn’t abruptly rising, and that she was taking her medication properly. The care manager also helped the patient, who could no longer afford all the medications, apply for a free-prescription program.