Transitioning to Value-Based Care

I am the president of MercyOne’s Population Health Services Organization (PHSO), a provider-driven and consumer-focused value-based organization founded in 2012 and headquartered in Des Moines, Iowa.

I transitioned to healthcare from the industry as a performance excellence facilitator for six sigma and lean process improvement. I was fortunate to transition to work with MercyOne’s ACO when it was founded back in 2012 and have been with that division since in a variety of positions. In 2019, I was appointed to the role of President for MercyOne’s PHSO. In this role, I have a responsibility for our population health value and risk-based strategy, MercyOne Business Solutions, and community health and well-being.

What are some of the major challenges and trends that have been impacting the value-based healthcare space lately?

Undoubtedly one of the most significant challenges has been the COVID-19 pandemic and transitioning resources to assist where we could provide value. Through this work it has only strengthened our commitment to value-based care and our response to the acceleration of these models here in the Midwest. This is as we see a renewed commitment not only from federal programs, Medicare, and Medicaid but also from existing and new-to-market commercial payers. As far as challenges are concerned, the pace of change in the market and the organization’s ability to pivot to be successful within value-based care remains a major focus.

In terms of technology and its impact on value-based care, a significant trend has been the movement towards incorporating digital and virtual care in which MercyOne is fully embracing this change as part of its value-based strategy. With the increased use of telehealth, our PHSO has and continues to actively adjust care management models to meet with patients virtually. The number of independent providers in our partnered provider network has also allowed MercyOne’s PHSO to ensure we connect the dots for each patient journey throughout the continuum of care, many times virtually.

Outside the incorporation of digital and virtual care, an early technology investment we made was the co-development of a robust data platform to have a seamless and improved view of our members. This was a foundational step to ensure success in value-based care as it allowed us to have a line of sight on those members and ensure their care is coordinated. We have since continued to expand the data and information in the platform as well as its use to improve the experience and outcomes for our members.

Could you elaborate on some exciting and impactful projects/initiatives that you’re currently overseeing?

While we continue our work with all payers to advance value-based care, an exciting project has been working on new payer arrangements focused on lowering costs and improving outcomes. These new models provide additional data, information, and collaboration. Through our work with our partnered provider network, the MercyOne PHSO care management team utilizes these additional insights to ensure each member’s care is coordinated. The quality of care has been shown to improve significantly as well.

How would you see the evolution a few years from now concerning disruptions and transformations within the arena?

Near term, you will see a continued trend toward provider organizations and health systems assuming more significant amounts of risk in order to share in the premium dollar. This will require organizations to build new competencies and invest in technology, staff, and other resources to navigate the transition to downside risk arrangements. The trend will also be working more closely with payers to deliver a unique experience to the consumer or employer, to demonstrate value through improved quality, experience, and lower cost.

Nationally, you will see greater movement toward capitated models as shared savings programs mature in a post-COVID period where health systems can refocus their energy on value-based care. With the disruption of telehealth in the pandemic, it is also likely there will be a greater acceptance of tech-based solutions, including payers, and nontraditional parties will continue to enter the healthcare market.

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What would be the single piece of advice that you could impart to your colleagues to excel in this space?

Look for ways to improve daily, and challenge the model with which you set out. Having practiced value-based care since 2012, we have gone through many iterations of our program and committed to PDCA (plan-do-check-act). We’ve made a conscious effort to continue to adapt and evolve to the market from a program designed for upside-only risk arrangements to a mature model designed to assume downside risk.