Medical Group Execs Detail Data Challenges With Commercial Value-Based Payment
During the Value-Based Payment Summit on Feb. 26, managers of several medical groups highlighted their successes and challenges in value-based care. They offered recommendations such as exploring ways to improve data transparency and reliability in commercial value-based contracts and working toward standardizing quality measures and reporting requirements across payers.
All three panelists brought together by the Medical Group Management Association for this event had fairly positive things to say about their experience with value-based care.
Gerard Filicko is executive director for Virginia Care Partners (VCP), a clinically integrated network in the Richmond metropolitan service area. He represents about 350 primary care providers. They operate in 32 different independent practices at 60 different offices. VCP has about 700 specialists that are also included in the network.
Filicko described how Virginia Care Partners was formed in 2013 to capitalize on the movement toward value-based care. “We do no fee-for-service contracting here. That’s all managed by the practices themselves,” he said. As a management services organization, VCP handles all of the administrative, technical and clinical needs in order to make the value-based contracts work. It has agreements with every major commercial payer in the market, multiple Medicare Advantage agreements, and an expanding Medicaid footprint, specifically for pediatric members. It also has two ACOs, a Medicare Shared Savings track E and new this year an ACO REACH model in partnership with Pearl Health.
“Our PCP practices have indicated that at least 85% of their businesses reimbursement is attached to some sort of a value-based arrangement that they have through Virginia Care Partners, Filicko said. “In some cases, it's it's 100% so every patient that's walking through their door has some sort of value-based care incentive program attached to them. We have generated over $100 million in cost savings to the medical community here over the past five years.
The adult primary care doctors in all of VCP’s contracts have been generating an additional $60,000 per doctor per year in incentive compensation tied to the contracts that VCP manages with them. “Our relationship with the payers is very strong. It's more collaborative than combative, and that's primarily because our interests are aligned,” Filicko e said. “They’re all shared savings or shared risk arrangements. So for the payer to be successful, or the self-insured employer to be successful, our network has to be and so it's actually established a very strong working relationship in the community.”
Christi Siedlecki, M.S., is CEO of Grants Pass Clinic, a 20-provider physician-owned practice that serves the Southern Oregon region as well as parts of Northern California. Grants Pass Clinic participates in many value-based care programs including Oregon’s collaborative care organization program and CMS’ Comprehensive Primary Care initiative. Now it is part of an ACO and participates in Primary Care First.
“We have at least 25% of our population attached to quality metrics. It has been really successful. We have generated revenue through the quality metrics,” Siedlecki said. “We feel like we are very good at it, especially if I'm careful with the contracts and align the measures as much as I can across all the payers. It's not to say that there aren't challenges, but overall, the satisfaction has been pretty good.”
Jeffrey Smith, M.B.A., is CEO of Piedmont Healthcare in Statesville, N.C., a 250-provider independent medical practice serving mostly the Charlotte metro area.
He noted that they started in value-based care by starting an ACO with a hospital. “We quickly realized that they knew less than we did, so we spun out as quickly as we could and did our own so we still have a traditional Medicare Shared Savings Program and also participate with all Medicare Advantage plans in the area,” Smith said. We are full downside risk.”
Piedmont Healthcare just entered into a Blue Cross commercial agreement that was effective January of this year. “That’s probably the scariest one that we're in right now,” Smith said. “Also, the one that sometimes folks forget about is your own employees if you're in a self-insured contract. So we are at full risk for that as well.”
Differences between commercial and government programs
VCP’s Filicko said his organization has grown its CMS footprint in both MSSP, ACO REACH and Medicaid, so that all of those contracts together represent almost half of its lives now. “So it's an even split between commercial and CMS. With the commercial contracts, what I have found is that there's a high degree of variability depending on market factors in terms of how we are rated, how we are scored, how the market is defined, and what those benchmarks are set for,” he added. “You don't have the same level of consistency that you get out of the Medicare program. The earnings potential has actually been greater on the government side than it is on the commercial side.”
In addition, he said, getting data from the CMS program that we can use is actually much better than it is on the commercial side. There is significant data lag on every commercial contract that we have and and typically the data is not complete,” Filicko explained. “A lot of the times, what is missing are paid claims amount, the things that actually show how we are doing. There's a number of our larger payers will have this black box mask that says, “Well, here's kind of a directed cost, but not the actual cost. That drives a lot of the way we operate, the way we manage. So in some cases, it's kind of a surprise whether or not we win or lose at the end of the period, depending on what the final reconciliation is. Behind the non-transparency and the significant lag, I think those are the two things that make me prefer the CMS’s feed and the information that we're getting out of the CMS program compared to what we're getting commercially.”
Siedlecki agreed that Grants Pass Clinic has had good experience getting data from government payers and the state of Oregon. But commercial payers “tend to be all over the place,” she said. I have some negotiating power to align the metrics, but each of the payers has their own monthly meeting to review metrics, their own portal to submit metrics, or own ways that you're allowed to submit metrics, and it takes a considerable amount of time. It would be much easier if everybody lined up and did things the same.”
Smith echoed what his colleagues said, but perhaps put it more bluntly. “Commercial is awful,” he said. “Blue Cross of North Carolina just cannot produce reliable data. So we are really having to make sure that we can produce data and go back to them and challenge what they sometimes present to us. So that’s the biggest concern. I think. On the Medicare and Medicare Advantage side, things have gotten better, but we still have variations from contract to contract, so you have to focus hard. And you know, it's a burden on on the docs and on the staff. I know we want to treat everybody the same, but just making sure that we're doing the right things to meet the right measures under each contract is onerous. But that's the hand we've been dealt, so that's what we're dealing with.”
Physicians more accepting of value-based payment
The medical group managers all said their providers are now more comfortable with value-based payment than they were a few years ago.
“We have tremendous stickiness with our primary care base, and I think that's driven in part because I have so many physician leaders who understand what it is, and they can actually talk to their peers about it,” VCP’s Filicko said. “My board chair has said for four years this is the way we should be practicing medicine. It makes sense to them, and I think the reimbursement model helps, but at the end of the day, what you're trying to do is elevate the care that's being delivered to a community of patients and highlighting those important things like gap closure and outcomes and overall costs, and so the primary care providers in my network get it now. They didn't at the beginning, but we've been doing this now for six or seven years. It takes time to get that.”
