On Tuesday, Nov. 17, Wednesday, Nov. 18, and Thursday, Nov. 19, the leaders of the Los Angeles-based APG—America’s Physician Groups—will present their virtual fall conference, the APG Colloquium 2020. As noted on its website, APG is “a professional association representing over 300 medical groups, independent practice associations, and integrated healthcare systems across the nation. We’re taking responsibility for America’s health by driving down cost and improving the health of the population. Our members are committed to responsible payment models that make them accountable for both cost and quality,” the association states.
At the Colloquium, among other sessions, attendees will hear Florida Rep. Donna Shalala address “The State of Healthcare in America” in a keynote session discussion, with APG president and CEO Don Crane; will hear Vivian S. Lee, M.D., president of the Health Platform at Verily Life Sciences, share “Lessons from the Long Fix: COVID-19 and Beyond”; will here Rishi Manchanda, M.S., CEO of HealthBegins, talk about the “Time to Move Upstream: The Fierce Urgency of Addressing Social Need and Social Determinants of Health”; and will hear Elizabeth Mitchell, CEO of the Pacific Business Group of Health, address the question, “Escalating Healthcare Costs for Employers: What’s a Business To Do?” Leaders will discuss the adaptations that their medical groups have made, during the COVID-19 pandemic; will examine the idea of whether the shift from volume to value in healthcare should be accelerated, even in the midst of the pandemic; and will look at the longer-term prospects for the value-based movement. A description of the conference can be found here.
Leading the event and the conference, CEO Don Crane will be participating actively in several of the sessions. This week, Crane spoke with Healthcare Innovation Editor-in-Chief Mark Hagland regarding the current moment for physician groups participating in value-based contracting. Below are excerpts from that interview.
What does the policy, regulatory, and payment landscape look like, from your perspective, right now?
Fortunately for us, our leading focus is the value movement, and that remains largely non-partisan. There’s almost a unanimity that we need to move away from fee-for-service. And if you asked 100 people what could be done to fix healthcare, nearly all would say, change the payment system. Interestingly, the Trump administration has been full-out in supportive of the value shift. And the Biden administration doesn’t want to seem to withdraw from that one iota. A little footnote on that: should the two Democrats win in Georgia such that there’s an effective majority in the Senate, there would be big pressure on the Biden administration to deliver a lot of stuff. And on a human level, as a guy who already has an overflowing desk—how much attention would they be able to spend on the value movement, and how much on health insurance coverage?
And we want health insurance coverage expansion; and one metaphor I’m fond of repeating over and over, is that, you can’t just put more people into a leaky boat, and if you add more people to that leaky boat, it’ll actually sink faster.
Could a change in emphasis or support on the Medicaid side make any difference for you?
It could, yes, particularly if there were a further expansion of Medicaid. And something like 80 percent of Medicaid is already managed care. So if you add more lives into that, that’s good for value. So yes, the expansion of Medicaid would inure to our benefit, yes.
So what are your top policy priorities for 2021?
Among them is to encourage more value-based contracting under Medicare Advantage. There really isn’t an awful lot of value-based contracting yet in a program that’s known for excellence. So, more risk-based contracting in MA; it actually remains the last bastion of fee-for-service. It remains an almost unappreciated fact: if health plans are paying nothing but fee-for-service, downstream to doctors, where are we? So that remains a priority. Another high-ranking priority is, you know, through the pandemic, we’ve shifted dramatically to telehealth; it’s subsided somewhat, but it’s now a feature of healthcare, and won’t go away. There now needs to be some follow-through around that.
And so when we have a telehealth visit, we need to be able to use that encounter for purposes of risk adjustment. And currently, the rule requires both an audio and a visual element, or it doesn’t count for the purposes of risk adjustment. Purely telephonic should be recognized; audio-only should be counted in risk adjustment analysis. And there’s a pending bill on it in the House. So that will remain a pretty high priority because, you know you have to get paid in life for the work you do.
Do you think that payment parity for telehealth will be maintained after the public health emergency ends?
I might be a little bit of an outlier on this. It’s pretty obvious that there’s lower overhead with a televisit; and we need to be honest about that, frankly. But this is where payment models make a difference. So those lobbying for payment party are in the fee-for-service lobby. And there is no payment amount per visit under capitated arrangements. And if all healthcare would be delivered by capitated groups, no one would care about that; so that’s an important footnote, frankly. So if it’s in parity, you’re encouraging fee-for-service. And why continue to encourage fee-for-service-related incentives?
Has the pandemic been less difficult for the most advanced groups, in terms of its financial impact?
Yes, we did a panel today in which we discussed that issue. And fact is that organized groups are nimble, creative, mobile, and adaptable. And so the question I opened the panel with was, so are you the same, or a different group than you were in January 2020? And to a group, they all said, we’ve learned so much, and we’re better, and we know what to do with regard to PPE and staffing and remote monitoring; we’ve gotten more capable.
And so I asked, we’re now facing this nightmare surge, the worst of the year. And how scared or confident are you this time around? And there was a quiet confidence across the group, that they’ll be able to handle it; they know how to do this. So it was really impressive, frankly, really impressive.
What does the state of data analytics feel like right now, to you?
It’s foundational to what my members do. They would be reckless if they didn’t have good data, good analytics, and good practices. Outside our membership, small and medium-sized groups just don’t have the resources. Our members: you need to know who has CHF [congestive heart failure], diabetes, COPD [chronic obstructive pulmonary disease], or you’re going to lose your shirt. And once you do know, you can take action. We do the outreach to patients. And that’s even before the use of artificial intelligence, which really is an extension of what we’re doing: it’s more algorithms, basically. And so we’re going to see more use of big data and artificial intelligence.
What do the next 24 months look like for APG’s member physician groups?
Well, if you reference the next 24 months, it’s important to note that there’ll be another election in 24 months, and there will be mid-term elections. And we have members in 45 states. And that’s important to note. And the next two years, it hinges a lot on what happens in the two Senate run-off races in Georgia. Georgia is equally important to the presidential election, because if you have a president with an aligned House and Senate, that’s one thing; otherwise, there could be continued quagmire and logjam. Beyond that, we’ll continue to see continued, slow growth of the value movement. There is a clarion call right now to double down. And people realize that 85-90 percent of the spend in the United States is around chronic disease. The purchasers are getting more and more restive. And I think we should watch the behavior of the health plans. They are not a monolith, and are not moving forward at equal paces.
Physician groups all over the country are having these conversations right now around their board tables, where they’re saying, we can’t stay in fee-for-service and be on the edge another 12 months from now. Even hospitals, even academic medical center leaders are saying, we need a new payment model. What is unknown is whether we see something big in terms of incentives from the U.S. Congress. Will they really incentivize the move to value or not? It’s been 10 years since the ACA, which created ACOs; and five years since MACRA [the Medicare Access and CHIP Authorization Act of 2015]. And the value movement is alive and well, but it’s a long way from fully succeeding. So let’s get going, Congress. The trust funds will be bankrupt by 2024; if you don’t move to a model that’s more cost-effective, you are going to go into bankruptcy as a country. So we’re going to continue to advocate for our model.
