Dan DiamondPanel 1: Can Fee-for-Service Reward Value? Ways to Adapt Today’s Payment Model
"One of the most interesting parts to me," my colleague Rob Lazerow told me, "was when Chet Burrell said we may be trying to move away from fee-for-service too fast." One reason, argued Burrell—the CEO of CareFirst BlueCross BlueShield—is that fee-for-service is the foundation of bundled payment and ACO models. He also discussed the role of PCPs and reviewed some of the financial drivers driving the need for lasting reforms.
.@CareFirst's Chet Burrell: We have to improve quality to reduce costs. For example, each readmission costs $20k. #innovatecare14
— Rob Lazerow (@roblazerow) February 27, 2014
@CareFirst Chet Burrell: HDHPs are trading "short-term savings for long-term disasters" for patients with chronic disease #innovatecare14
— Lisa Bielamowicz, MD (@LisaB_MD) February 27, 2014
"Another highlight was Stephen Zuckerman from Urban Institute saying that it was unclear if we're here to bury or fix FFS," Rob added.
Panel 2: Accountable Care 2.0: Next Steps in Advancing ACO-Led Innovation
This session reviewed early lessons from the most successful participants in the Pioneer and ACO program, and I caught up with the Advisory Board's Hamza Hasan, who sat in.
Jim Coleman, the COO at Marshfield Clinic, pointed out that "at a certain point there is only so much you can get done by the care delivery system," Hamza said. And one of Marshfield's "biggest areas of focus has been at partnering with all the community partners, since that's what's the patient needs."
Jim Coleman from @mfldclinie: Biggest lesson learned: "Didn't expect the degree in variation in physician practice" #innovatecare14
— Brett Erhardt (@Brett_Erhardt) February 27, 2014
There was also a "spirited group discussion" about the role of IT in population health, with acknowledgement of the challenges when getting started—but the huge upside in getting it right. According to Hamza, one panelist thought of IT in population health "not as a means of checking the box to get meaningful use dollars, but to a greater end of improved patient care. You always have to keep the end goal in mind."
Panel 3: Valuing New Advancements in Care: How Is Value Measured, Who Determines Value, and Why Does It Matter?
There was considerable discussion of "the need to get away from a one-size-fits-all model for evaluating new treatment options," Megan Clark told me. Panelists also focused on the need to increase the speed of innovation and the ability to attract money and talent to solve health care problems, she added.
One major question around "value"—and making sure that you get value for delivering value—is the ability to more quickly and effectively get the necessary data for regulatory and reimbursement decisions, Megan said.
Panel 4: Innovation Incubators: Exploring State Approaches to Payment Innovation
Daily Briefing editor Juliette Mullin sat in this breakout session, where health care leaders from four states discussed state-level approaches to health care innovation.
Oregon Health Authority Director Bruce Goldberg explained how the Northwestern state has taken "a different path" by focusing on local delivery reform rather than benefits and payment reform, Juliette told me. Scott Fenn—the Chief Integration Officer at Baptist Health System in Alabama—said that his state was influenced by Oregon's approach, noting that Alabama's "Medicaid director calls [Goldberg] all the time."
Also during the state breakout session, Rhode Island's Jennifer Wood explained how, without making the appropriate investments in an IT infrastructure, states "really can't do population health."
Which data sources do states use? In Vermont, "most reliable & clean" is own all-payer claims database. Next: clinical data. #innovatecare14
— Rivka (@RivkaFriedman) February 27, 2014
Panel 5: How Innovative Employers Are Using Their Purchasing Power to Drive Value
I was in this session, moderated by Anton Gunn and featuring panelists from Virginia Mason Medical Center, Pacific Business Group on Health, Compass Care Engineering, and Iora Health.
The panelists acknowledged the challenge—and opportunity—of having employers play a role in health care coverage and delivery. On the one hand, firms feel a different kind of pressure than payers and providers; while a health plan or hospital might be content with the current fee-for-service model and rising health spending, a private business might be especially motivated to push for reforms.
On the other hand, businesses have been burned before by the promise of cost controls that never panned out—like managed care and consumer-directed health care—and that's one reason why some firms are likely going to get out of providing health coverage, David Lansky of PBGH pointed out.
Meanwhile—and I'm not sure how much this relates to the role of innovative employers—but Iora Health's CEO Rushika Fernandopulle shared a striking anecdote from one of his practices.
CEO of @Iorahealth: Even at #InnovateCare14, we forget the one thing that really matters in healthcare. pic.twitter.com/1z0PsdwDEZ
— Dan Diamond (@ddiamond) February 27, 2014
My colleague Cabell Jonas joined me, and I asked what stood out to her.
"I was struck by the commentary about moving beyond the 'PCP shortage' discussion into a discussion focused on team-based care, and the fact that the problems that need solving aren’t always medical," Cabell said. "Usually one person mentions this, but in this discussion, three panelists underscored its importance."