Muskingum Valley Well being Heart (MVHC), a neighborhood well being middle with 13 places in 4 rural counties in japanese Ohio, has jumped on the value-based care bandwagon and even created a value-based care division with 19 R.N. care managers. CEO Dan Atkinson not too long ago spoke with Healthcare Innovation about MVHC’s participation within the ACO REACH mannequin.
Becoming a member of the dialog was Misty Drake, vice chairman of consumer providers and progress at Medical Residence Community (MHN), a public profit company centered on reworking care within the security web by partnering with FQHCs on ACO REACH, the Medicare Shared Financial savings Program (MSSP), and different value-based care applications. MVHC is one in every of its parters. (In 2024, Healthcare Innovation interviewed Cheryl Lulias, president and CEO of MHN.)
Healthcare Innovation: Dan, may you speak about why Muskingum Valley is interested by these value-based care fashions?
Atkinson: Worth-based care is important to the way forward for healthcare. We jumped on this mannequin of care early on. As soon as sufferers have entry to major care, we are able to actually begin to create extra worth, which goes to avoid wasting authorities and personal payers cash by enhancing entry, and in the end enhancing outcomes. Now we’re on this mannequin the place we’re managing these parts that actually drive price.
HCI: Why did you select to work with Medical Residence Community on this?
Atkinson: We felt that we had a shared imaginative and prescient of what it meant to do value-based care. They have been in a position to propel our value-based care mannequin to the place we wished it, not just for the Medicare inhabitants, however we have been in a position to duplicate that for all populations.
HCI: Misty, has the variety of FQHCs that MHN works with continued to develop? And will you speak about the way you establish which neighborhood well being facilities are prime candidates to work with? Have they got to have a sure stage of tech or analytics sophistication for it to make sense so that you can work with them?
Drake: We’re presently partnering with greater than 80 well being facilities throughout eight states. We’re very strategic when it comes to how we develop these partnerships. We additionally work with major care associations and FQHC-led IPAs. Initially, we ask: Are they prepared to consider follow transformation? As a result of it is extra than simply implementing the mannequin of care. It is extra than simply hiring the RNs. You actually should suppose by way of delivering care otherwise. As a result of you’re looking at measures that well being facilities sometimes do not take a look at.
What CMS or any of those value-based preparations are taking a look at is lowering whole price of care. That is actually the underside line. They need you to handle utilization, they usually need your sufferers to have acceptable utilization with their PCP follow. That requires you to suppose otherwise when it comes to how sufferers entry you. And Muskingum Valley has carried out job of pondering exterior the field when it comes to how sufferers entry them for care once they want it essentially the most.
HCI: Dan, has the usage of embedded care managers modified the way you work together with sufferers? Or are there different methods you may have modified how sufferers can entry the well being middle?
Atkinson: There are a pair other ways, I believe. One, we have leveraged know-how. Even with the Medicare inhabitants, we’re utilizing energetic textual content messaging. Entry is on the middle of every little thing we do at MVHC, so we all know that the better we make entry achievable, it’s going to in the end result in decrease price, as a result of more often than not when sufferers find yourself within the hospital for an unplanned admission or overutilize the ED, it is as a result of they felt like, for some cause, they could not entry their major care supplier.
We attempt to make that as simple as potential. We at all times joke and say that the emergency room is our No. 1 competitor as a result of it’s at all times there 24/7. Our sufferers are a bit of bit like water, looking for the trail of least resistance. We have to make their path to accessing major care as simple as it’s to go to the emergency room. So we have carried out a few various things. We now have pressing care that operates seven days every week. Even when they’re seeing somebody there aside from their major care supplier, we have now the document of these visits in our digital medical document. That connectivity provides us the flexibility to deal with that affected person from a holistic standpoint.
The opposite side, after I speak about know-how, is figuring out the place and when our sufferers are accessing the emergency room or have an admission, and the follow-up that goes with it. So we’re always reaching out to our sufferers after an pointless ER utilization to have a dialog and discover out what prevented them from coming to the well being middle. If it was an admission that wanted to occur, we will make it possible for we do good follow-up care to maintain them out of the hospital to keep away from a readmission.
HCI: Do you get ADT feeds from an HIE when one in every of your sufferers results in the hospital?
Atkinson: Sure, there’s a well being data change that we’re a part of known as CliniSync. It notifies us when a affected person has been admitted to the hospital or been by way of the ER. And we work intently with our hospitals, too. We’re in a position to leverage partnerships with the hospitals in our space, and we have some joint efforts to attempt to actually assist handle that price of care.
Drake: I believe Dan touched on a very good level. One of many issues that they’ve carried out rather well has been round understanding when their sufferers are utilizing the hospital and and having that 360-degree affected person view, and bearing in mind that built-in medical, behavioral and social wants information.
Oftentimes, what’s a problem for major care suppliers is to have the ability to risk-stratify sufferers. Who do I must get in now versus who do I must get in later? That is one thing that we have labored with their workforce on — to actually prioritize these sufferers who’re in danger for readmission or for having one other inappropriate utilization, in order that they will handle the amount of ED alerts and inpatient alerts that come by way of and arrange the workforce extra successfully. The opposite factor, as Dan talked about, is that robust hospital relationship. When you may have a hospital that additionally desires to stop readmissions, that’s whenever you’re cooking with fuel, since you guys have a shared worth in making certain that that affected person is definitely getting the proper care on the proper time, on the proper place.
Additionally, what works in rural Ohio might be very totally different from what works in rural Oklahoma. However the hot button is combining a confirmed mannequin with the flexibleness to adapt to the native context.That is how we have been in a position assist well being facilities in very totally different settings obtain significant, sustainable change.
HCI: Are you able to speak concerning the outcomes Muskingum Valley has been seeing within the ACO REACH program?
Drake: Once we first approached Muskingum Valley, we knew that it was more likely to have a loss within the first yr. One of many the explanation why we wished to work with them was that stage of dedication to say this can be a mannequin that we need to embrace. They have been already beginning to interact in lots of the follow transformation work, and we have been fairly assured that as we labored collectively we have been going to have the ability to flip that round. So we have been projecting that they have been going to have a medical loss ratio of about 105% and I believe, within the first yr, they really ended at 104%.
Inside a yr they decreased that medical loss ratio, and this yr they’re at 85%. That comes with a lower in all prices — readmissions, decreasing utilization throughout almost all classes, and presently they’re projecting to have about $2.2 million surplus by the third yr. That actually comes from the work of their workforce in getting sufferers extra linked with their major care suppliers.
HCI: Are there some challenges you need to work by way of with the follow to maneuver to a extra team-based strategy?
Drake: The great thing about it’s that well being facilities have at all times supplied some care administration providers. Including parts resembling threat stratification has been comparatively new, and that could be a robust a part of our mannequin. The one factor that we have now leveraged is extending the care workforce to take note of non-licensed people to assist to assist addressing social determinants of well being. You actually do not want a nurse to try this. So how do you usher in that subsequent era of healthcare workforce, beginning them off doing care coordination actions, and having them actually be part of the care workforce?
HCI: Dan, out of your perspective, are there some other classes discovered that you’d share with different neighborhood well being facilities?
Atkinson: I believe that it is vital whenever you enterprise down this value-based highway to have a companion like an MHN, as a result of they create a component to the desk that it’s extremely arduous as a well being middle to duplicate. Whether or not it is the know-how side and the chance stratification greatest practices, after which the flexibility to take the information that is available in from CMS and put that in a reportable format that is comprehensible, not solely to the enterprise facet of issues, but additionally the scientific facet of issues. Additionally they assist with supplier engagement. How do you encourage suppliers to suppose otherwise about how they ship care?
It is so important for well being facilities to go down this path as a result of income streams have gotten more difficult, proper? We’re always coping with the monetary challenges as an FQHC. If we did not have value-based income, we might not be capable of proceed to do what we do, and broaden providers and see extra sufferers. This partnership has allowed us to springboard our total program to the following stage.
