Biggest Hurdle in Shift to Value? Physician Engagement

Ambitious objectives for a health plan are at the center of CHI's strategic vision for the future. Getting buy-in and support from its 4,000-plus physicians is "where the hard work resides," says one senior executive.

In July 2014, Englewood, CO-based healthcare giant Catholic Health Initiatives—which operates 105 hospitals in 19 states—rebranded its insurance arm as Prominence Health and set out on a mission to use its health plan products and services to support the organization's transition to value-based care delivery.  

In addition to operating CHI's commercial and Medicare Advantage health insurance plans, Prominence's goals include aligning and coordinating the system's healthcare delivery networks, data analytics tools, and disease and care management services.

A Strategic Vision Based on Value

While these may be ambitious objectives for a health plan, they are at the center of CHI's strategic vision for the future. Prominence will serve as a "catalyst to position us as a broadly integrated health system," says Juan Serrano, president and CEO of Prominence Health and CHI's senior vice president for payer strategy and operations.

"I think at the board level our philosophy at CHI is to embrace and support the health plan business because it is relevant to what we believe is the new era of expectation that health systems will integrate care delivery with how healthcare is organized and purchased by employers and consumers," Serrano says.

"That confluence of healthcare delivery and the way customers and consumers purchase and utilize healthcare benefits and services is a critical part of what we think is going to drive the value proposition in the healthcare industry going forward."

To keep pace as healthcare shifts away from traditional fee-for-service payment structures, Serrano says, CHI must find ways to rein in costs while maintaining and improving quality and outcomes. Prominence Health, he says, is a linchpin of that approach.

"We wanted to adapt to take responsibility for the total cost of care. We are being asked by the federal government, state governments, insurance companies, other health plans, and consumer stakeholders to hold ourselves more accountable because what we do relates to their total costs," he says.

"We are escalating our understanding of what it means to integrate providers and a health plan, to operate that plan, and to organize a network and system of care. Along the way, we believe it will make us a better system partner for every stakeholder across the continuum."

Creating a Culture Shift

While there are many challenges involved with implementing such sweeping, organization-wide changes, Serrano says getting buy-in and support from CHI's 4,000-plus physicians is "where the hard work resides."

"It is not in operating a health system or a health plan. It is driving integration at the point of care delivery so we are really positively impacting the health of the individuals we serve and becoming accountable for the cost of care. That is the culture shift," he says.

Serrano is certainly not alone in his assessment. In HealthLeaders Media's recent Intelligence Report, "Physician Alignment: Today's Strategies Require Risk and Clinical Integration," 66% of respondents cited physician engagement as being one of their organization's top alignment objectives, and it is most frequently cited as being the most difficult objective to achieve (24%).

One key to success, Serrano says, will be to "break down the siloes" that commonly exist between providers and payers to align the entire organization around the concept of value.

Make a Wholesale Shift to Value

"The hard work is in moving away from that idea that payers are there simply to pay for health services and providers are there only to provide care. We have to align the two in order to improve the health of our communities," he says.

"That will go a long way to developing our strategy over the next five to ten years, really teasing out how we can make that happen and doing it in a way that can be replicated throughout our markets."

Incenting a Change

Prominence Health is encouraging physician engagement through financial incentives, Serrano says, such as orthopedic bundled payments and other value-based reimbursement arrangements.

"There is most certainly a correlation between payment and the degree to which a provider in the system feels accountable at the very least for generating positive outcomes and falling within acceptable value ranges for performance parameters that are being reported out. That is augmented tremendously when they have some skin in the game," he says.

Boost VBP with Financial Incentives for Physicians

"The motivation for folks is sometimes altruistic, sometimes economic, and sometimes both, but the industry is moving in this direction as payers are demanding more accountability from providers."

Enhancing Value with Data

Using data to determine evidence-based best practices for patients across the care network is another way to align physicians with organizational goals and to create an environment centered on value, Serrano says.

"We are not only delivering data about an individual to a physician and hoping the physician will use it to improve the way they serve that individual, we are actually using the information to engage the health system collectively and to activate interventions across the continuum for the individual," he says.

"This involves the physician, the specialist, and the hospital if a hospitalization is needed and is also about organizing the rest of the care around the person."

Looking for Physician Champions

Although getting to the tipping point where the majority of physicians are on board with CHI's efforts to integrate its provider network and health plan may take a while, Serrano says the organization is starting by working with those who are open-minded about approaching their work differently.

"Like any large group of individuals who are contemplating change, we have some physicians who were ready before we even shored up our strategies and who have become champions for this type of population health work," he says.

"At the other end of the spectrum, there are those physicians who just are not predisposed to working in this manner and are not as receptive. We are working initially with those who more naturally gravitate toward this style of working."

Making steady progress in physician engagement will ultimately position CHI for success in a value-driven environment, Serrano adds.

"It's a journey we are on. Three years from now, we will have really moved the sentiment of physicians within the system toward one where they expect to work in this manner and to receive this kind of information and support."