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.