A demonstrated commitment from providers is the dividing line between value-based care initiatives that succeed and fail, according to Priority Health's network leader.
Mike Jasperson, senior vice president of provider network and health plan operations at the Grand Rapids, Mich.-based payer, told Becker's hoping a value-based contract works out is not a plan for success.
"That is not a recipe for adding value to the communities we serve," he said.
Providers have to make some kind of investment in infrastructure to make value-based arrangements work, Mr. Jasperson said.
"That can be analytics, pharmacy, engagement with clinical leadership to drive care transformation, investments in EMR platforms and the ability to better manage patients at point of care," he said. "It's those types of investments where you're getting beyond traditional thinking around fee-for-service and simply driving volume."
In 2020, Priority Health launched a full-risk contract with Grand-Rapids-based Corewell Health. The contract covers 170,000 lives across Medicare, Medicaid, commercial and individual markets.
As of 2022, the contract had saved an estimated $45 million in healthcare costs, Mr. Jasperson said. The program decreased hospitalizations by 6% and emergency room visits by 2%. Primary care visits increased by 15%.
The kind of full-risk contract between Priority Health and Corewell Health is possible because the two organizations are integrated, Mr Jasperson said. The contract accounts for over $1 billion in premium revenue.
Around 40% of healthcare spending in 2022 was fee-for-service only, according to a survey from the Healthcare Payment Learning and Action Network. Growth in value-based arrangements remained stagnant from 2021 to 2022.
A shortage of capital is one of the major things holding back value-based care, Joshua Kaufman, MD, medical director of behavioral health and medical integration Capital District Physicians Health Plan, told Becker's.
"Capital can mean many different things. One, is the raw capital, money itself, and the capital we can analogize in terms of providers. There's a shortage of providers, there's a shortage of money to pay the providers. Because of that, that interferes with certain companies feeling comfortable to take on risk," he said.
CDPHP implemented value-based payments for primary care providers treating opioid use disorder, adding up to $188 in additional payments per visit for treating the condition.
As part of its Courage to Care program, the Latham, N.Y.-based payer also implemented a series of webinars designed to educate providers on medication-assisted treatment for opioid use disorder.
Providers may feel uncomfortable prescribing controlled substances used to treat opioid use disorder, so more education was a key component of the program, Dr. Kaufman said.
"We felt the combination of highlighting the incentive and increasing the rigor of education of our providers, that would be the key to open the lock to allow providers to walk through that door," Dr. Kaufman said.
Not every organization has the capacity to take on full-risk contracts, Mr. Jasperson said. Priority Health has an alternative payment model index to assess what types of risk an organization can take on.
"We really do view these as partnerships. We want them to be successful. Simply throwing risk over the fence to another entity doesn't make sense to us," he said.
Over the years, Priority Health has refined its approach to value-based contracting. The insurer has worked to maintain consistent processes and reporting across its more than 100 value-based arrangements, Mr. Jasperson said.
Priority Health has also become more selective about which value-based deals it takes on, Mr. Jasperson said.
"If it's not a win-win-win — meaning a win for the provider organization, a win for us, a win for the communities we serve — we really have to question: Is it worth it? We've found ourselves being more and more vigilant around making sure we're picking the right partners and that we're staying and investing in the right partnerships," he said.