Late last autumn, in preparing our January-February cover story on our State of the Industry Survey and its findings, Healthcare Innovation Editor-in-Chief Mark Hagland interviewed a variety of healthcare industry leaders for their perspectives on the survey results. Among those he interviewed were Jeff Bailet, M.D., president and CEO of the San Francisco-based Altais Clinical Services, a division of the healthcare services company Altais—initially launched last year by the San Francisco-based Blue Shield of California, to help physician groups succeed under value-based contracting, through the leveraging of data analytics tools. Hagland spoke with Dr. Bailet in the same interview along with Kelly Robison, president and CEO of the 1,700-physician, San Francisco-based Brown & Toland Physicians group. Bailet and Robison shared a range of perspectives on the survey results and on the current landscape around value-based contracting, and the horizon for value-based contracting under the new Biden administration, in the next couple of years. Below are excerpts from their interview.
We asked several questions in our State of the Industry Survey regarding data analytics to support success under value-based contracts. That’s a key area of your collaboration as organizations, correct?
Jeff Bailet, M.D.: Yes, that’s what Brown & Toland is doing today for their physicians, and we’re helping them with additional investments in technology, and will make investments in Brown & Toland to help them accelerate the strategy that they have in place. And Brown & Toland will remain intact. Kelly’s doing a fabulous job running her organization, and will continue to do that.
Kelly Robison: It would be helpful to talk about the market landscape. There’s been so much consolidation; the industry is moving very quickly. And information technology is more important than ever. And it’s gotten harder and harder for physicians to invest in IT; but studies have shown that the quality can be higher in open IPA practices. And helping practices remain independent is good for quality of patient care and patient satisfaction. So let’s help independent physicians remains viable.
In that regard, we asked survey respondents were they were on their analytics journeys. Our survey found that 37.41 percent of respondents described themselves as “advanced” in their analytics development, and 38.1 percent said they were “early on” in their analytics journey. But 12.24 percent indicated that they have not used data analytics until now, and a further 12.24 percent have no plans to use data analytics on any level of scale.
Bailet: COVID really exposed the lack of resilience in the medical system, and how fee-for-service payment really is not sustainable; it really exposed the underlying challenges with fee-for-service,” Bailet says. “And a lot of practices are no longer in business, because they lost 70 percent or more of the revenues early on. And even some sophisticated integrated health systems are really struggling right now. And that was an ‘aha’ moment, where physician leaders realized that had they had more value-based contracts, they would have done better during COVID. But you need the infrastructure, the analytics, including predictive, and clinical decision support, to be successful.
At this point, in the industry, there’s an acknowledgement of how powerful technology can be if it’s deployed in the right way. And there’s an awareness among medical group leaders that they need to pursue value, and that they need technology to do that. I serve on the Physician Panel for HHS, we review proposals with stakeholders across the country, we work with CMMI [the Center for Medicare & Medicaid Innovation, a division of the Centers for Medicare & Medicaid Services]. So designing a comprehensive model is really, really difficult, but I think the payers are wanting to get into this space more forcefully, but they need a high-performing group of physicians who are engaged and who want to take on the value contract, and have the support and the infrastructure to do well.
The discussions around the social determinants of health (SDOH) have intensified in the last few years. Asked whether they’re incorporating SDOH into their population health management and care management work, 43.54 percent of survey respondents said yes, while 34.01 percent said they’re planning to do so soon. Only 22.45 percent said they have no plans to do so.
Robison: The social determinants of quality will pose both an opportunity and a challenge. There are a lot of factors that come into play in terms of how to better deliver care and achieve holistic outcomes—how to integrate mental health back into care as well as nutrition, transportation, etc., that’s something that the entire healthcare industry has to prioritize.
I think that physicians by nature tend to be entrepreneurial, and I’ve been in healthcare for nearly three decades,” she observes. “Over the years, the management of healthcare has become so complex, and there’s been such a squeeze on reimbursement, and on top of that, there’s been so much consolidation that now, a physician’s range of choices is so different. So for those physicians who want to remain entrepreneurial, and who want to remain independent and not have their destiny controlled by a hospital-based system, they need some kind of help. And that’s where organizations like ours can help: we can support physicians in their practices, while allowing physicians to retain an entrepreneurial spirit.
More broadly, how do you see information technology evolving forward to support value-based care delivery?
Robison: I think the next couple of years are going to be really challenging, even with the fantastic news about the vaccine. COVID’s here to stay for a while and will have a direct impact on how physicians practice. So helping physicians to bridge this time period will be important. The technology of telehealth is here to stay. And physician groups are bringing in social determinants in important ways. And Jeff uses this phrase a lot, about trying to decrease the burden on physicians in practice. And while Jeff and I are excited about this deal that took a long time to emerge, the timing couldn’t be better. Physicians need a little bit of assistance to bridge this time when there’s been a dip in elective care. So the more we can do to decrease the burden on them in value-based arrangements, to keep that cash flow as steady as possible, and then the technology and other things to make their day-to-day lives easier, that’s really where we need to focus our energies.
What are your thoughts on a new administration coming in?
Bailet: It’s hard to say. I was appointed by Sylvia Burwell under the Obama administration, and worked with [Health and Human Services] Secretary Tom Price and then Alex Azar. The majority party changed, but a lot of the work around value and trying to make healthcare more affordable for Medicare beneficiaries, a lot of that work continued forward. I would not expect a significant left or right turn in the next couple of years. There may be some modifications or nuances along the way, but I would not expect a dramatic shift away from value.
Could it accelerate the shift to value?
I ‘m not sure, because CMS [the Centers for Medicare and Medicaid Services] has been pretty driven to get value-based models into the field.
Robison: I agree with Jeff; I don’t see any major, dramatic shifts. The current administration was on the path of starting to peel away from the ACA [Affordable Care Act]; we’ll see more support for the ACA in the new administration. But CMS has been trying to be very progressive in terms of getting more and more patients into value-based care, and I think that that good work is going to continue.
