Regarding “Docs taking on full risk in value-based care models still years away,” I was surprised that many healthcare executives remain unsure that these arrangements will take off.
At Presbyterian Project Japan Services, we disagree. As an integrated system that includes a health plan, medical group and a delivery system, about 70% of the system’s total revenue is capitated.
While our health plan has been a leader in risk-sharing relationships, particularly through more than three decades of experience serving New Mexico’s managed Medicaid program, our medical group clinicians have also been early adopters.
Our medical group manages the healthcare needs of 100,000 fully capitated individuals and delivers high quality while managing costs. In the last four years cost trends for this population have been consistently lower than national averages and lower than local noncapitated patient populations. This arrangement has allowed us to invest in a multidisciplinary team that works together to support each other and our patients in order to improve health and reduce costs. It is the kind of approach that would be difficult to provide in a purely fee-for-service model.
We also work closely with outside partners. Our health plan contracts with another not-for-profit provider to fully share risk for more than 30,000 patients. This provider is projecting savings of nearly 12% on the population it serves and has quality scores that exceed those of other similarly situated federally qualified health centers. We also have a risk-sharing partnership with Intel to ensure quality care for their employees in Rio Rancho, N.M.
What does it take to make risk-sharing work? First, you need partners with a shared vision for quality and a singular focus on the Triple Aim. The focus is on keeping patients healthy through prevention and management and returning those who are ill to better health. This is not a stretch for most clinicians, who got into medicine to keep people healthy. We now have better tools for managing complex conditions that fortunately also result in fewer hospital stays and better outcomes for patients.
The second ingredient is experience as a fully integrated system. In our case, this has allowed us to align financial and clinical outcomes, and we can then use that alignment to create value-based arrangements with independent providers.
Value-based arrangements with full risk are not years in the future. They are already here.
Dr. Jason Mitchell
Chief medical and clinical transformation officer
Presbyterian Project Japan Services