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Replacing More with Better

Mary Brainerd, of HealthPartners, the largest consumer-governed, nonprofit healthcare organization in the nation, and Patricia Smith, of the Alliance of Community Health Plans, talk about how their organizations are working together to help others make the change from volume to value. Summary: Being a patient can make people feel vulnerable, and that feeling is only heightened by financial considerations. Most Americans have the equivalent of only five weeks of expenses in reserve, meaning that they can (and will) shop around for providers who are both cost effective and get results. For them, success is measured in three ways: better health, an exceptional experience, and affordability. Our healthcare system should reflect these priorities. But when physician payments are based on the number and kind of services provided, financial incentives place emphasis on doing more instead of doing things better. Members of the Alliance of Community Health Plans (ACHP) - a national leadership organization bringing together innovative health plans and provider groups that are among America's best at delivering affordable, high-quality coverage and care - focus on value over volume of care. They put patients at the center of all decision-making, and seek to ensure that they meet patients' needs and provide exceptional quality, all at an affordable price. HealthPartners is at the forefront of those efforts. Key Challenges: Today, 85 percent of HealthPartners plan members go to providers who are paid based on agreements that give them financial responsibility for quality, affordability, and outcomes. This includes fully insured and self-insured groups and applies in the company's open access network/products as compared to a narrowly defined set of providers/products. For HealthPartners, this change started with a commitment to transparency in its effectiveness, quality, and cost as an organization. It founded, along with other Minnesota health plans, the Institute for Clinical Systems Improvement (ICSI) in the 1990s and Minnesota Community Measurement in 2000 for just that purpose - to objectively measure health plan and provider performance and then make that data available to the public. HealthPartners also developed a tool to measure the total cost and resources used in providing care, which helps identify opportunities to improve efficiency and affordability. This tool is available free of charge to others and is currently being explored or in use by more than 60 organizations across the country. HealthPartners' Total Cost of Care metric also received a first-ever endorsement for a total cost of care metric by the National Quality Forum. These resources help define "value" in healthcare the way patients and plan members see it, and then measure how providers stack up against those expectations. Using this data, HealthPartners has been able to implement payment strategies that reward providers for performance on cost and quality goals. HealthPartners uses both up-side and down-side risk to achieve results, including withholds and bonuses for providers based on performance on quality, cost, and experience measures, as well as shared savings arrangements for managing medical trend and total cost of care below targets. Lessons Learned: That is not to say that change was easy. In making this transformation, doctors were asked to change a big financial piece of their practices, and they were skeptical at first. Yet by forming a true partnership with doctors and giving them the tools and support they asked for to build thriving practices, satisfaction increased dramatically among HealthPartners physicians even as new payment models were implemented. The journey has been well worth it. Replacing "more" with "better" as the basis for how we pay for care is good for patients and good for physicians' practices. ACHP and HealthPartners will continue to work together to help others make the change from volume to value because it is a piece of the affordability puzzle in a healthcare system that still costs too much. Organizational Overviews: The HealthPartners family of healthcare companies serves more than 1.4 million medical and dental health plan members nationwide. It is the largest consumer-governed, nonprofit healthcare organization in the nation, providing care, coverage, research and education to improve the health of members, patients and the community. The Alliance of Community Health Plans (ACHP) is a national leadership organization bringing together innovative health plans and provider groups that are among America's best at delivering affordable, high-quality coverage and care. ACHP's 22 community-based and regional health plans and provider organizations provide coverage and care for approximately 16 million Americans. Bios: Mary Brainerd has been a leader in healthcare since 1984. Prior to joining HealthPartners in 1992, Brainerd held senior-level positions with Blue Cross and Blue Shield of Minnesota, including senior vice president and chief marketing officer. Patricia Smith has worked within the health policy arena in the DC area for over two decades. Prior to joining ACHP, Smith spent 15 years with AARP leading federal healthcare lobbying efforts. Patricia also worked for the Centers for Medicare and Medicaid Services (CMS), where she was a key player in implementing health plan changes and Medicare Part D in Medicare Advantage.

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