Muskingum Valley Well being Heart (MVHC), a group well being heart with 13 places in 4 rural counties in jap Ohio, has jumped on the value-based care bandwagon and even created a value-based care division with 19 R.N. care managers. CEO Dan Atkinson not too long ago spoke with Healthcare Innovation about MVHC’s participation within the ACO REACH mannequin.
Becoming a member of the dialog was Misty Drake, vice chairman of consumer companies and progress at Medical Dwelling Community (MHN), a public profit company centered on reworking care within the security web by partnering with FQHCs on ACO REACH, the Medicare Shared Financial savings Program (MSSP), and different value-based care packages. MVHC is one among its parters. (In 2024, Healthcare Innovation interviewed Cheryl Lulias, president and CEO of MHN.)
Healthcare Innovation: Dan, might you speak about why Muskingum Valley is concerned about these value-based care fashions?
Atkinson: Worth-based care is significant to the way forward for healthcare. We jumped on this mannequin of care early on. As soon as sufferers have entry to main care, we will actually begin to create extra worth, which goes to save lots of authorities and personal payers cash by enhancing entry, and in the end enhancing outcomes. Now we’re on this mannequin the place we’re managing these parts that actually drive value.
HCI: Why did you select to work with Medical Dwelling Community on this?
Atkinson: We felt that we had a shared imaginative and prescient of what it meant to do value-based care. They have been in a position to propel our value-based care mannequin to the place we needed it, not just for the Medicare inhabitants, however we have been in a position to duplicate that for all populations.
HCI: Misty, has the variety of FQHCs that MHN works with continued to develop? And will you speak about the way you determine which group well being facilities are prime candidates to work with? Have they got to have a sure degree of tech or analytics sophistication for it to make sense so that you can work with them?
Drake: We’re at the moment partnering with greater than 80 well being facilities throughout eight states. We’re very strategic when it comes to how we develop these partnerships. We additionally work with main care associations and FQHC-led IPAs. To start with, we ask: Are they prepared to consider follow transformation? As a result of it is extra than simply implementing the mannequin of care. It is extra than simply hiring the RNs. You actually must suppose by way of delivering care otherwise. As a result of you’re looking at measures that well being facilities sometimes do not take a look at.
What CMS or any of those value-based preparations are is decreasing whole value of care. That is actually the underside line. They need you to handle utilization, and so they need your sufferers to have acceptable utilization with their PCP follow. That requires you to suppose otherwise when it comes to how sufferers entry you. And Muskingum Valley has completed a great job of considering outdoors the field when it comes to how sufferers entry them for care after they want it probably the most.
HCI: Dan, has using embedded care managers modified the way you work together with sufferers? Or are there different methods you’ve gotten modified how sufferers can entry the well being heart?
Atkinson: There are a pair other ways, I feel. One, we have leveraged know-how. Even with the Medicare inhabitants, we’re utilizing lively textual content messaging. Entry is on the heart of every part we do at MVHC, so we all know that the simpler we make entry achievable, it’ll in the end result in decrease value, as a result of more often than not when sufferers find yourself within the hospital for an unplanned admission or overutilize the ED, it is as a result of they felt like, for some cause, they could not entry their main care supplier.
We attempt to make that as simple as doable. We at all times joke and say that the emergency room is our No. 1 competitor as a result of it’s at all times there 24/7. Our sufferers are somewhat bit like water, in search of the trail of least resistance. We have to make their path to accessing main care as simple as it’s to go to the emergency room. So we have completed a few various things. We now have pressing care that operates seven days per week. Even when they’re seeing somebody there apart from their main care supplier, we’ve the file of these visits in our digital medical file. That connectivity provides us the flexibility to deal with that affected person from a holistic standpoint.
The opposite side, after I speak about know-how, is understanding the place and when our sufferers are accessing the emergency room or have an admission, and the follow-up that goes with it. So we’re continually reaching out to our sufferers after an pointless ER utilization to have a dialog and discover out what prevented them from coming to the well being heart. If it was an admission that wanted to occur, we’ll ensure that we do good follow-up care to maintain them out of the hospital to keep away from a readmission.
HCI: Do you get ADT feeds from an HIE when one among your sufferers results in the hospital?
Atkinson: Sure, there’s a well being data alternate that we’re a part of known as CliniSync. It notifies us when a affected person has been admitted to the hospital or been by way of the ER. And we work carefully with our hospitals, too. We’re in a position to leverage partnerships with the hospitals in our space, and we have got some joint efforts to attempt to actually assist handle that value of care.
Drake: I feel Dan touched on a very good level. One of many issues that they’ve completed rather well has been round understanding when their sufferers are utilizing the hospital and and having that 360-degree affected person view, and making an allowance for that built-in medical, behavioral and social wants knowledge.
Oftentimes, what’s a problem for main care suppliers is to have the ability to risk-stratify sufferers. Who do I have to get in now versus who do I have to get in later? That is one thing that we have labored with their crew on — to essentially prioritize these sufferers who’re in danger for readmission or for having one other inappropriate utilization, in order that they will handle the amount of ED alerts and inpatient alerts that come by way of and manage the crew extra successfully. The opposite factor, as Dan talked about, is that robust hospital relationship. When you’ve gotten a hospital that additionally needs to stop readmissions, that’s once you’re cooking with gasoline, since you guys have a shared worth in making certain that that affected person is definitely getting the best care on the proper time, on the proper place.
Additionally, what works in rural Ohio may very well be very completely different from what works in rural Oklahoma. However the secret is combining a confirmed mannequin with the pliability to adapt to the native context.That is how we have been in a position assist well being facilities in very completely different settings obtain significant, sustainable change.
HCI: Are you able to discuss concerning the outcomes Muskingum Valley has been seeing within the ACO REACH program?
Drake: After we first approached Muskingum Valley, we knew that it was prone to have a loss within the first yr. One of many explanation why we needed to work with them was that degree of dedication to say this can be a mannequin that we wish to embrace. They had been already beginning to have interaction in loads of the follow transformation work, and we had been fairly assured that as we labored collectively we had been going to have the ability to flip that round. So we had been projecting that they had been going to have a medical loss ratio of about 105% and I feel, within the first yr, they really ended at 104%.
Inside a yr they decreased that medical loss ratio, and this yr they’re at 85%. That comes with a lower in all prices — readmissions, reducing utilization throughout almost all classes, and at the moment they’re projecting to have about $2.2 million surplus by the third yr. That actually comes from the work of their crew in getting sufferers extra related with their main care suppliers.
HCI: Are there some challenges it’s important to work by way of with the follow to maneuver to a extra team-based strategy?
Drake: The fantastic thing about it’s that well being facilities have at all times offered some care administration companies. Including elements reminiscent of danger stratification has been comparatively new, and that may be a robust a part of our mannequin. The one factor that we’ve leveraged is extending the care crew to consider non-licensed people to assist to help addressing social determinants of well being. You actually do not want a nurse to do this. So how do you usher in that subsequent era of healthcare workforce, beginning them off doing care coordination actions, and having them actually be part of the care crew?
HCI: Dan, out of your perspective, are there every other classes discovered that you’d share with different group well being facilities?
Atkinson: I feel that it is necessary once you enterprise down this value-based highway to have a companion like an MHN, as a result of they carry a component to the desk that it’s extremely arduous as a well being heart to duplicate. Whether or not it is the know-how side and the danger stratification greatest practices, after which the flexibility to take the info that is available in from CMS and put that in a reportable format that is comprehensible, not solely to the enterprise aspect of issues, but in addition the scientific aspect of issues. In addition they assist with supplier engagement. How do you inspire suppliers to suppose otherwise about how they ship care?
It is so important for well being facilities to go down this path as a result of income streams have gotten more difficult, proper? We’re continually coping with the monetary challenges as an FQHC. If we did not have value-based income, we might not be capable to proceed to do what we do, and broaden companies and see extra sufferers. This partnership has allowed us to springboard our total program to the subsequent degree.
