In any ongoing relationship communication is key, right?
We know that without it, our needs aren’t known. Our needs aren’t met. No one is happy. Call in the counselor!
The same holds true in the sometimes acrimonious union between two of the most influential forces in senior health care: payers (insurance companies) and providers in post acute care, rehab and long term and assisted living companies. It’s a relationship that affects all of us.
The Historically Rocky Marriage Between Providers and Payers
Just think about the road you travel if you need post acute care––and we’ll all need it. It’s fraught with competing, siloed interests. Different providers. Different payer sources. Data isn’t always properly gathered, used or shared. Goals aren’t aligned. And the worst part? The patient doesn’t benefit from integrated, personalized care.
It’s not for a lack of wanting to make things better. There are a lot of incredible people with huge hearts and expertise in this industry. So, where’s the breakdown? Why aren’t the two sides effectively communicating? How do we get the focus back on the patient?
A New Trend in Senior Health?
This edition of the Aging Right blog gives you a glimpse of how we can achieve that triple win––for the insurance payer, the service provider and, most importantly, the patient.
You’ll hear from two transformational senior health care and insurance industry leaders who are racking up some impressive data on what happens when two disparate sides effectively communicate.
The Director of Clinical Services for Regence BlueCross BlueShield of Oregon is Veronica Sheffield, M.S., BSN. She coordinates the Regence Gold Card membership. Her focus is keeping her members healthy and happy and controlling costs. She’s done that by creating a Value Based Agreement (VBA) with the Chief Medical Officer of Avamere Family of Companies, Dr. Elizabeth Burns. Sheffield and Burns worked together at Regence and understand the payer challenges. When Burns moved to Avamere, she was able to share the perspectives of the provider and the payer.
Surprising and Exciting Results
Data shows the two partners are checking all the right boxes: reducing costs, inefficiencies and redundancies; producing best patient experiences, satisfaction and outcomes; and delivering shared savings and increased market share due to happy customers.
Those are huge wins that may entice other payers and providers to start talking. Now, let’s hear from these two innovators:
Q: Thank you for talking with us, Dr. Burns and Ms. Sheffield. What were your goals with your partnership and the VBA?
Dr. Burns: We wanted to find a new way of working together to create an outstanding customer experience while delivering on quality patient centered outcomes. We knew we could meet those goals if we had a like-minded partner who was willing to listen. We wanted to align our economic and quality goals to produce high customer satisfaction with quality outcomes for both acute care partners and our patients, residents and health plan members.
Ms. Sheffield: We also agreed to quality metrics for readmission reductions, Emergency Department reductions and length of stay. A VBA agreement must be focused on common goals. We’ve accomplished that and we’re aligned.
Q: What value did the VBA bring to your members?
Ms. Sheffield: There are all kinds of benefits we were pretty sure we’d see and some wonderful surprises. Our Regence members receive better, easier, more affordable care in our Value Based Agreements with provider partners.
Dr. Burns: For us, PAC Net providers were able to do what they do best––focus on compassionate patient-centered care. The ease of administrative burden and aligned goals allow us to create a better experience for the patient, our staff and the payer team. Our collaboration frees us to focus on the entire spectrum of the post acute episode. This includes a short stay as well as the transition back to the patient’s home and ensures our patient’s health care needs are coordinated. All of this provides a better patient experience.
How is your collaboration working in the acute care setting?
Dr. Burns: Our VBA approach has improved our relationships with not only our payer partners like Regence, but also the acute care setting due to the ease of the discharge process. Patients are leaving the acute care setting at the right time in their health care journey.
Q: Is this a more holistic view of patient health?
Ms. Sheffield: Our collaboration with our provider network is deep and wide. So yes, because we really talk with each other, we’re able to deliver a more holistic view of patient health and thus a better experience of care and improved coordination of health care needs. For example, Regence members who receive care from a VBA provider report higher satisfaction with their care than non-VBA members.
Q: Does your data show members are going to the doctor more or less?
Ms. Sheffield: Our data shows that better coordination and care are leading to fewer unnecessary medical appointments, diagnoses and treatments, all resulting in lower member out-of-pocket costs. That’s huge! Through our VBAs, we’ve seen improvement in quality-of-care measures as well as lower inpatient admissions and catastrophic care spending.
Q: That’s remarkable. Do patients and staff understand how this level of communication is changing their care?
Dr. Burns: Definitely! We are both aligned and coordinated on behalf of the patient and the additional services and support that the health plan has to offer allows for a streamlined transition without fragmented care across the health care continuum.
Q: There’s now a critical focus on how to lower opioid use and abuse. Has this collaboration resulted in any improvement there?
Dr. Sheffield: I’m glad you asked that. Yes, we’re finding this kind of tailored care is resulting in fewer opioid prescriptions filled and that’s a very good thing. From 2015 to 2020, Regence helped reduce opioid prescriptions 51 percent through medication policy and management, broad education and awareness and supporting community nonprofit organizations on the front lines of addiction support and prevention.
Q: What would you tell your other payer partner colleagues about this kind of VBA collaboration?
Ms. Sheffield: Ultimately, VBAs are about paying for consumer-centric health care based not on volume, but on what matters most: quality and results. Regence first launched its VBA provider networks in 2013, so we’ve spent years building expertise and relationships with provider partners to drive a higher quality, cost effective health care experience.
We’ve developed a variety of arrangements to serve providers, sharing data, resources and expertise to improve cost and quality and enhance member care. This ranges from inclusive care management models to value based networks that create a deeper engagement between the patient and the provider.
The bottom line is our deep provider collaborations deliver a more holistic view of patient health, thus a better experience of care and improved coordination of cost effective health care needs.
Dr. Burns: I would invite them to talk to us and realize we are transformational leaders in post acute care. We’re the boots on the ground. We understand the needs and can collaboratively work together to create a win-win-win: Patient satisfaction. Payer satisfaction. Provider satisfaction.
Q: So, in the perfect world, where would the Value Based Agreement be in the short term and long term?
Ms. Sheffield: Regence has VBAs in all our markets, spanning care sites from primary and specialty care to hospitals and post acute. New models are constantly in development. We remain committed to working with our provider partners to grow the number and value of our VBAs to deliver a better health care experience for our members, employer groups and providers.
It’s sure working for patients, payers, providers and the PAC Net providers!
You can learn more about VBAs in this video interview with Ms. Sheffield and Dr. Burns on the AgeRight PAC Network Value page.
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Aging Right Hacks From Our Experts:
Dr. Elizabeth Burns:
Next time on the Aging Right Blog: Let’s have some fun with the numbers! Chief Financial Officer of Marquis Companies and Consonus Healthcare, Steve Fogg, will pull out the white board and show us how Value Based Agreements can improve the financial impact for all payers and providers.