Using Multi-Payer Alignment Can Improve Health Care Quality

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Using Multi-Payer Alignment Can Improve Health Care Quality

This month, the Washington Health Alliance ended our 2021 Framework for Action Series with the Bree Collaborative with an inspiring and informative discussion on how multi-payer strategies can support value-based payment.

“Teamwork” is the most important component of primary care transformation at the practice level, according to Lisa Dulsky-Watkins, MD, Director, Multi-State Collaborative with the Milbank Memorial Fund. Dulsky-Watkins works nationally to align payers as part of the Comprehensive Primary Care Plus (CPCS)program in the Centers for Medicare & Medicaid Services Innovation. She says success depends on “creating a team that actually works as a team, so that everybody who works with patients, has the freedom to work at the top of their training, people are doing the jobs for which they are trained, and there is open and consistent communication among the team to enhance the care for the patients.” In addition, she says there must be seamless communication, patients having a medical home, involving patients and their families in care decisions, adequate care coordination, access to services without barriers, and actionable, accurate, and timely information.

Health Care Authority (HCA) Medical Director Emily Transue, MD, MHA, has been helping lead the Washington State Multi-Payer Primary Care Model. She summarized HCA’s efforts to support primary care transformation through aligning payment and care incentives, increasing the spend on primary care, and improving provider capacity through actionable analytics. The proposed payment model includes:

  • a transformation of care fee to integrate behavioral and physical health in a range of settings;
  • a prospective Per Member Per Month comprehensive primary care payment to cover the cost of basic primary care services; and
  • performance incentives after three years, according to clinical care and utilization measures.

Transue said they are working on a centralized provider certification process that would begin with self-attestation and become more rigorous over time. The clinical quality measures that will be used to measure performance are child and adolescent well-care visits and immunizations, screenings for depression and breast, cervical, and colorectal cancer, controlling high blood pressure, managing asthma and antidepressant medication, diabetes care, and emergency department visits and follow up after an emergency department visit for alcohol and other substance abuse.

In answering the question, “What do we need to keep moving?” Transue said “We really need the continued commitment of all stakeholders in moving this forward and that includes providers and provider systems, payers, purchasers/employers have played a really critical role, obviously patients, and, of course, the state. And we need really hands-on engagement in the constructive process.” By that, Transue added, it’s important for all stakeholders to focus on solutions rather than the challenges.

Michael Myint, MD, Physician Executive for MultiCare Connected Care with MultiCare Health System described the challenge in moving towards more multi-payer alignment. “We live in a fee-for-service and a fee-for-value world. MultiCare has really worked hard to take on more value-based arrangements and move in that direction, and yet, we’ve acknowledged that we will be in a fee-for-service and value mixed world, just in different proportions. And trying to live in both, one foot in each canoe underestimates the challenges of care transformation in both of those spaces.”

Christine Palermo, MD, FACP, CPC, Medical Director of Business Services with Virginia Mason Medical Center, agreed. “The greatest challenge is the fact that the vast majority of our provider systems, ourselves included, do have one foot in value base care, one foot in fee-for-service, but therein is also the opportunity because that activation energy hump that we need to get over to be able to transform and transition our care practices is actually revenue. And that is where the opportunity to partner with payers as well as employers makes a big difference.”

There are success stories of multi-payer strategies, according to Angie Sparks, MD, President of the Washington Academy of Family Physicians, who serves as Medical Director Clinical Knowledge Development & Support with Kaiser Permanente Washington. She says the use of virtual care during the pandemic is a prime example. “Especially in getting alignment with payers, purchasers, and providers on what needed to happen on behalf of patients, so that they had an experience where they could access care through virtual platforms which were at that time safer and more efficient in a lot of ways. We are starting to learn some efficiencies through that that are really exciting and it does demonstrate that collaborativeness that we’ve been talking about.”

The state’s Multi-Payer Primary Care Model will be moving from general principles to more detailed implementation through the next year with an expected launch date of January 1, 2023.

You can view the webinar, presentations, and the National Academies of Science, Engineering, and Medicine report discussed during the webinar.

Save the date for the next webinar in this series on January 13, 2022 at 10 am PT, when we discuss Social Determinants of Health. Stay tuned for details!

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