health care

Summit explores payment reform models

Posted 6/24/13

PROVIDENCE – Top leaders of Rhode Island’s health care industry sector gathered on June 19 for a half-day summit at the Warren Alpert Medical School at Brown University to discuss the state’s progress in moving from fee-for-service toward bundled payments and accountable care organizations.

The session, hosted by Lt. Gov. Elizabeth H. Roberts as part of the Healthy Rhode Island initiative to develop a state innovation model, featured Chas Roades, chief research officer from the Advisory Board Company in Washington, D.C.

Roades presented an in-depth overview of leading payment reform models to more than 75 health care leaders, saying the speed of transition would be critical to success. He likened the current situation to trying to have your feet in two different boats, creating great difficultly for hospitals, providers and health insurers to straddle the situation.

Roades said that there was a limited time frame – about five years – to make the transition from volume to value in a fully integrated system of health care. “We need to rip the band-aid off,” he said.

The second half of the summit featured a panel discussion, moderated by Roberts, with a number of Rhode Island health care leaders who shared their perspectives on the challenges of implementing payment reform.

Dennis D. Keefe, president and CEO of Care New England, shared his vision about the emphasis needed on the continuum of care and the need to better understand and make more transparent the actual costs of running a hospital.

Lou Giancola, president and CEO of South County Hospital, discussed the way that his hospital had embraced the creation of a primary care network, with the resulting decrease 10 percent decrease for inpatient hospitalizations during the last year. He predicted that he expected some hospitals in the state were no longer financially viable and would need to close.

Dr. Gus Manocchia, senior vice president and chief medical officer of Blue Cross & Blue Shield of Rhode Island, talked about the investments that the health insurer had made in the patient-centered medical home in most of the large group practices in Rhode Island, and the focus will now turn toward many of the smaller practices. He said that patients needed to better understand the costs of medical care.

Dr. Al Kurose, president and CEO of Coastal Medical, said that he believe that Coastal had “reached the dock” in its efforts to achieve savings through its shared savings contracts with health insurers, its 365-a-day capability to see patients, and with its shared savings ACO with Medicare. It has required an investment in health IT and analytics, and new kinds of personnel to manage the team approach to care and the benchmarking of outcomes. Kurose said he expected the first payments under the shared savings contracts would go out to providers sometime this year.

Chuck Jones, CEO of Thundermist Health Center, a community health center, talked about the importance of maintaining a safety net while at the same time responding to the needs of an financially struggling community, finding ways to cut down on unnecessary specialty visits and emergency room visits.

Joan Kwiatkowski, president and CEO of PACE-RI, an integrated health service agency that employs an innovative model of care that enables eligible seniors to remain in their own communities rather than being placed in long-term care facilities,, said she was thankful for being included in the conversation. She talked about the need for a more inclusive approach with health care beyond hospitals and doctors and insurers dominating the discussion, recognizing the importance of integrating long-term care into the equation.

“Today we met our main objectives for the summit,” said Roberts, being informed about the payment reform models available and to hear from the state’s industry leaders’ experiences with implementing some of these models. The discussions, she continued, will help “to inform the plan we are working on to coordinate reform efforts in a way that helps Rhode Islanders get and stay healthy, while managing the increasing cost of health care.”

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