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“To ensure financial sustainability as payment models change, healthcare providers need to simply their operations and deliver consistent outcomes for all patients in their value-based contracts,” says Ceballos, Chief Operating Officer, Mount Carmel Health Partners.

Ceballos is a speaker at the marcus evans ACO & Payer Leadership Summit Fall 2018, in Irving, Texas, September 17-18.

Healthcare organizations are transitioning to a value-based system. What will this change really require?

It requires new ways of thinking, operating and delivering care. Going forward, payers will be in the business of writing risk-bearing contracts to providers. Managing patient populations in this environment will require an evolution in provider operations. It is not only about care management and understanding the upside and downside of risk-bearing contracts, but most importantly understanding how to get consistent, high quality healthcare outcomes from all providers in the practice. Consistent outcomes for Medicare, Medicaid and commercial populations, while making sure high-quality patient care remains at the center of everything they do.

Payers will try to offload as much risk as possible, so providers need to simplify operations focusing on the key value drivers to continue to deliver value. They have to think more holistically and consistently about their priorities. It is not just about what the patient presents in front of them, but the gaps in care that need to be closed for that individual as well.

What advice would you give for continuing to ensure financial sustainability whilst delivering on population health goals?

Population health management is a good way to reduce the total amount of units of healthcare utilized, but not the only way to reduce overall costs. We have to ensure the unit cost is also appropriate, that specialists are high quality, care is delivered at the most appropriate site, and if it can be delivered in an outpatient setting it should be. When people are transitioning out of an inpatient setting, going home ought to be considered as a first option. Certain elements of the cost equation really need to be thought through again. We have to educate families and patients on how to make the best decision on their next site of care. That is where case management comes in, and discharge planning as soon as someone is inpatient.

How does a simplified and centralized structure enable success?

At Mount Carmel Health Partners, we have 11 ACO contracts, four of which are Medicare and seven are commercial. None of them have the same quality or utilization metrics, yet. Historically we used to talk to our clinically integrated network providers about 11 different goals and incentives. It was very confusing and we could not deliver a clear and succinct message. That also played out within our employee population as it was a different story with every patient population.

How we have evolved, is to modify how we think about our population. For everyone under 65 we now have three priorities to focus on, regardless of what commercial or Medicaid ACO they are part of. For everyone over 65, we have another three priorities regardless of ACO. We are keeping it simple and consistent to make sure we drive value for each one of those populations. We cannot stress enough the need to address the gaps in care and make sure to keep people within the clinically integrated network, as that leads to better quality outcomes and minimizes task duplication.

What tactical strategies would you suggest for aligning payer and provider financial models?

Risk-bearing provider groups need to deliver consistent results across patient populations and tell payers exactly what outcomes to expect. Delivering on those outcomes will provide value to the patients and the payers. Providers should be compensated appropriately for delivering that value.

 Ahead of the marcus evans ACO & Payer Leadership Summit Fall 2018, 
Michael Ceballos discusses how simplicity and consistency of care delivery can be achieved

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September 17-18, 2018

Four Seasons Resort & Club Dallas at Las Colinas, Irving, Texas