As healthcare costs continue to rise, health reform initiatives across the country are working diligently to achieve the Triple Aim – (1) improve the patient’s experience of care, (2) improve the health of populations, and (3) reduce the per-capita cost of healthcare. One promising approach: providing population-based management fees and shared savings opportunities to primary care practices in an effort to improve the efficiency and efficacy of healthcare delivery.
An early front-runner of this movement is the Health Collaborative with its Comprehensive Primary Care (CPC) initiative funded by the Center for Medicare & Medicaid Innovation (CMMI) at the U.S. Centers for Medicare & Medicaid Services (CMS). Established in 1992, the Health Collaborative brings together regional stakeholders – health plans, health systems, private providers, community organizations, and consumers – to develop a connected system focused on transparency and accountability. The ultimate goal of their work: improving the public’s health status, experience, outcomes, and affordability across healthcare settings.
Most recently, the Health Collaborative has been working on several interconnected projects aimed at transforming the Greater Cincinnati region’s healthcare delivery system in order to change how the community perceives and receives its health services. Their multifaceted approach includes actively managing and facilitating smooth transitions of care from one venue to another (from a hospital to a rehabilitation center to home care, for example), leading quality and cost transparency efforts across physician groups and hospitals, and addressing overall population health by identifying non-traditional drivers of health status and healthcare across the region.
One of the Health Collaborative’s major undertakings is its CPC initiative, which serves 75 primary care practices representing more than 250 physicians, bridging counties in southwest Ohio with those in northcentral Kentucky. After soliciting interest from payers nationally, the CMMI selected the Cincinnati-Dayton region in April 2012 as one of its seven CPC sites. Since then, the Ohio-Kentucky CPC initiative, convened and led by the Health Collaborative, has quickly become the demonstration’s leader in fostering collaboration between public and private healthcare payers to strengthen primary care.
The five comprehensive primary care functions exhibited by the initiative include: (1) providing greater access and continuity to care, (2) developing team-based approaches and personalized plans of care to effectively meet patients’ needs, (3) implementing risk-stratified care management for patients with high needs, (4) engaging patients and their families across all aspects of care, and (5) working with patients and providers to better coordinate and manage care experiences.
Dr. Richard Shonk, the Health Collaborative’s Chief Medical Officer (CMO), notes that individual payers began noticing significant, constructive results in their data soon after the initiative’s launch in 2012. While the positive results for individual payers were reassuring to the initiative and its overarching vision, Dr. Shonk reinforced the essential need to evaluate whether the project’s approach could also produce positive results at an aggregate level across all participating payers. “Although each individual payer could see their own slice of the data, and that data was indicating exciting results, what we really needed was a more systematic approach to determine whether individual practices were performing and reaching the outlined functions of the comprehensive primary care model.”
To guide its efforts in creating this critical resource for evaluating overall program effectiveness, the Health Collaborative is partnering with Onpoint Health Data to build a “Shared Data Platform.” This cross-payer database, which opened its doors this month (May 2015), begins with data collection and integration followed by performance measure production and reporting by Onpoint. The reporting will inform providers and other key stakeholders on how healthcare is being delivered across the region from a utilization, cost, and quality perspective. The initiative’s focus on expanding transparency and accountability across the region’s participating primary care practices is one of the most exciting parts of the project, says Dr. Shonk.
With more than a decade’s experience as a primary care physician, Dr. Shonk is hopeful that the initiative’s comprehensive functions and Shared Data Platform will make the life of a practicing primary care physician a little easier. “It’s no secret that there’s a shortage of primary care physicians, mainly because we’ve created a job over the years that physicians no longer want to do. With the fee-for-service model, physicians feel like they’re constantly running on a treadmill,” he notes.
The Cincinnati-Dayton region’s payment reform efforts “will begin to pay primary care physicians to provide a more universal oversight of healthcare instead of simply taking care of the next sore throat or high blood pressure patient. In other words, physicians will be getting back to the kind of work they were trained for as healthcare professionals with the implementation of a value-based payment system.”
Given the program’s promising results to date, participating payers have been advocating for the expansion of the project’s approach beyond its defined region. With this month’s launch of the Shared Data Platform, that effort – and the study of overall cross-payer dividends – begins. Stay tuned for future updates on the Health Collaborative’s ongoing efforts to build a regional culture of team-based care coordination and payment transformation.