Leadership Health Care (LHC), a Nashville Health Care Council program for emerging leaders, Cohorts provide the participants an opportunity to engage in a peer mentoring program facilitated by an experienced healthcare executive. Throughout six cohort sessions, participants discuss substantive topics around a common focus area to enhance their knowledge and leadership skills.
Insights from Clayton Meyers on Value-Based Care
As the healthcare landscape increasingly shifts toward value-based care, the importance of effective attribution models cannot be overstated. Clayton Meyers, Head of Finance at Chamber Cardio shared insights on the often complex relationship between payers and providers, particularly regarding member attribution—a challenge that can create significant hurdles for healthcare organizations. By exploring these dynamics, Clayton emphasized the need for robust attribution strategies as a foundation for achieving success in value-based care initiatives.
The Importance of Attribution Models
Clayton opened the conversation by addressing a critical question: What is the minimum panel size necessary for effective attribution in VBC models? He emphasized that while payers often express enthusiasm for engaging with behavioral health providers, they quickly pivot to discussions about member attribution. Clayton recounted his experiences where payers expect providers to attribute members, which poses a significant challenge, especially for those with existing downstream contracts.
Drawing on the Centers for Medicare & Medicaid Services (CMS) guidelines, Clayton explained that a sound risk pool typically requires around 5,000 patients for average primary care physician membership. However, for more specialized programs, like the Comprehensive Kidney Care Contracting (CKCC), this number can be significantly lower, around 1,000 patients.
Navigating Specialty Risk Pools
Clayton discussed the complexities of setting up specialty risk pools and the necessity of achieving the right density of engaged patients. He advocated for a path-to-risk approach, which allows organizations to manage specific conditions or patient types rather than diving fully into risk. This model helps mitigate risk while building a foundation for future growth.
He also highlighted the potential benefits of partnering with other VBC companies to create carve-out arrangements. This strategy enables organizations to trigger new arrangements once they engage a sufficient number of patients within a partner’s network, fostering collaboration and reducing risk.
Payer Alignment and Engagement
Aligning with payers is crucial for the success of VBC initiatives. The discussion highlighted how payers should view VBC companies as partners rather than just vendors. Misalignment can occur when payers prioritize short-term savings at the expense of long-term care outcomes.
As Clayton noted, the financial structure of these contracts can lead to misaligned incentives, particularly in full-risk arrangements where payers may not have a strong incentive to engage. A shared risk model, where both parties have a stake in the outcomes, is essential for fostering collaboration.
Managing Complexity in Value-Based Contracts
Clayton further elaborated on the diverse landscape of VBC contracts, asserting that no two contracts are alike. This variability can create friction for providers who must navigate multiple agreements simultaneously. To simplify this process, he suggested that VBC enablement companies focus on holistic management, minimizing the burden on providers.
By streamlining the relationship and offering clarity on metrics and incentives, organizations can empower providers to concentrate on patient care rather than getting lost in the complexity of contracts.
What The Future Holds for Value-Based Care
The conversation around value-based care underscored the importance of adaptability and innovation in managing risk and aligning incentives. As organizations navigate the complexities of VBC, focusing on building robust networks, refining attribution models, and fostering payer engagement will be vital for long-term success.
By addressing these challenges head-on, healthcare providers can not only improve patient outcomes but also create sustainable financial models that benefit all stakeholders involved.
The Next Generation of Healthcare Leaders
Leadership Health Care’s mission is to cultivate talented healthcare professionals into the industry leaders of tomorrow. LHC aims to provide young professionals with ongoing opportunities to develop their knowledge of the healthcare industry through educational events and networking opportunities. Fill out this form to learn more about LHC.