Now well into our sixth year of operation, Mary Washington Health Alliance
is clicking on all cylinders and accelerating forward in the world of
value-based healthcare. 2017 was a solid year of performance in nearly
every program in which we participated. As reported elsewhere in this
newsletter, we saved more than eleven million dollars in the MSSP program
and will receive over 5 million dollars for those efforts.. We also demonstrated
savings in our value-based commercial contracts.
I want to congratulate the membership for the work and effort provided
to enable these results. One of the challenges facing the Membership and
Operations committee is to determine the ideal performance distribution
model for the Alliance membership. This is the type of challenge one cherishes
as it implies there is a distribution coming. Past performance as a rationale
for bonus distribution should be an incentive for all to motivate increased
membership activity in our value-based contracts, which in turn augments
success both in our financial and our quality goals.
Our current distribution model is heavily weighted towards the primary
care physicians, and for the near future will continue in that capacity
if not be even weighted more towards the PCPs. The rationale is that by
whatever lens one uses to assess who did the work necessary for our achievements,
it points to the primary care physicians. The quality measures needed
to succeed were generated by the work in the primary care offices. Via
the efforts of Annual Wellness visits, 18 of the necessary quality measures
were collected. This required significant changes in how primary care
offices functioned, disrupting previous processes while adopting new ones.
Likewise, the work performed in the HCC coding effort required changes
internally in primary care offices. These adjustments were vital to achieve
success in all of the above contracts.
Yet, I don’t believe this is the ideal model for performance distribution,
although for now, it is the best we have. We need to get much more granular
in how we recognize who is doing the work, who is making the adjustments,
perhaps even sacrifices for the Alliance to be successful. Surely not
all PCPs warranted credit for our success. Likewise, we may not be adequately
recognizing the efforts of specialists who helped reduce spend while maintaining
high quality standards.
This is the true challenge Membership & Operations Committee faces
as they move forward, and frankly, it is a challenge for the entire membership.
Now more than ever, continued financial success will greatly depend upon
the performance of physicians. Unfortunately, it is very difficult to
gauge specialty performance, as ACOs across the nation have discovered.
In fact, many ACOs exclude specialists from performance distribution altogether.
I for one am not in favor of that. I want to reward those financially
who are making the changes necessary in how they practice medicine for
the Alliance to succeed, regardless of their specialty.
One concept to consider is having physicians within our Alliance create
programs that can lower spend while maintaining or increasing quality.
It makes sense that physicians within a specialty have better insight
into ways to improve their current protocols and processes. Individual
group practices or a division of specialists working collaboratively can
present new pathways to the Alliance for consideration. If the program
succeeds in both quality and financial measures, then performance distribution
monies will be awarded to the successful entities. This also fortifies
the concept of the Alliance being a physician led organization.
For the time being we will continue with the plan we have in place with
tweaking from year to year as is always necessary. But I would much rather
empower the membership to lead this process and receive the rewards for
the efforts they apply.