Speaker talking to many other business professionals at a business conference

As hundreds of healthcare professionals took their seats for the the 2015 NAMCP Managed Care Forum in Las Vegas, the opener ended his introduction with a sentiment that elicited subtle nods: “We are in a challenging, yet interesting, time for the healthcare industry.”

Providers across the spectrum are seeing rising costs and demand for accountability paired with an increasingly difficult patient population, which wants care when it wants it, in the shortest amount of time, for the fewest dollars.

The goal of the transition from fee-for-service to value-based care is to lower costs and improve patient health while also ensuring a provider’s bottom line remains sustainable in the long-term. But how is this best executed?

ACOs and clinically integrated networks are key, the speakers agreed, but so is not jumping the gun. Organizations need to think about operations first, said Lillian Lee-Chun, a manager at ECG Management Consultants. They need to research and understand their local market dynamics, technological platforms, and opportunities for reimbursement. Reducing utilization of high-cost services through disease management, nurse navigators, preventive wellness, and other strategies could eventually hit a group’s bottom line, said Chun, so providers should plan appropriately to seek fair and valuable reimbursements.

To see successful models, one could look at Banner Health in Arizona, Memorial Hermann in Texas, or Care4Texans, also in Texas. Banner Health bills itself as a clinically integrated organization (CIO) co-owned and co-governed with two physician groups: Banner Medical Group and Arizona Integrated Physicians. It has a statewide presence, which Jacque Sokolov, M.D., chairman and CEO of SSB Solutions, thinks is invaluable. “A total state presence gives you state employees and a whole lot of markets,” he said.

Memorial Hermann also considers itself a CIO, and a large part of its success comes from its broad reach. It has more than 200 locations in a 60 by 60 mile primary service area in Houston and has been taking advantage of synergies in retail health and satellite emergency departments. Sokolov believes health systems need alternative delivery sites like these to ensure patient reach without breaking the bank.

A driving factor of success for the Care4Texans (C4T) is its physician-led approach, something that did not initially come easy. Brett Esrock, CEO of Providence Health Network who sits on the Board of Directors for C4T, said getting physicians to be main drivers in the C4T strategy elicited eye rolls.

“Essentially we had to develop a vision for the organization instead of just guiding principles. There were more eye rolls than you could shake a stick at. We distributed vomit bags for people who really didn’t want to participate.”

Eventually, physicians saw that C4T could contribute to real cost-savings, and they established their vision. Today, more than 300 physicians are part of C4T.

Overall, speakers seemed to agree on one thing: Adaptation to new modes of care, whether it be telemedicine, partnerships with retail clinics, or clinically integrated networks, will soon be imperative to staying financially successful and socially relevant. Keeping an open mind and being willing to change is what will differentiate the best from the average. Evolution of healthcare is here, and unavoidable.

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