The shift from fee-for-services payments to capitation has spurred the myriad of advanced payment models. Insurers, healthcare organizations, and physician-led accountable care organizations are experiencing the wave of payment change.  The shift to global payment is being driven by increasing healthcare costs resulting in changes to the current reimbursement structure.  Innovations to increase access to higher quality care at lower costs is a challenge faced by leaders in all areas of healthcare.  Achieving success with quality performance programs and payment transformation require all hands on deck.  

 

The Hawai'i-Pacific Chapter ACHE recently put out questions on the topic of Payment Transformation to Gerard Livaudais, MD, MPH, FACP, Vice President, Hawai'i-Health Partners ACO and Travis Clegg, MBA, FACHE, Operations Executive, Adventist Health Castle. We believe our readers will find their responses insightful, informative, and timely.  

 

 

Dr. Livaudais:  The influence is immense and has had a profound and direct impact on our strategy.  As we've taken significant early steps to adapt to new payment models, we've come to understand the depth and breadth of changes needed across the system - spanning clinical, finance, accounting, technology and nearly every aspect of our enterprise.  It's not an exaggeration to state that our organization is revisiting nearly every aspect of our operation to align with new payment models.

 

Mr. Clegg:  Adventist Health Castle has embraced the recent policy changes and movement toward value-based care including payment transformation.  Our organizational strategy has responded to these changes by increasing our focus on primary care.  We are also examining our organizational infrastructure to ensure we are prepared to deliver outstanding evidence-based care to our community in a transformed payment environment.

 

Dr. Livaudais:  My role spans helping the organization as a whole make sense of the changing market circumstances, strategize and communicate to the various leaders of our business and operational units so they too can understand the reason for change, and how to approach change in their areas.

 

Mr. Clegg:  As operations executive I am active in both the development and deployment of strategy related to payment transformation.  It's a role that I enjoy because it is incredibly rewarding to see a good idea grow and develop into a fully realized and successful program.

 

Dr. Livaudais:  Perhaps most important is the attitude toward change. Consistently across many different areas, individuals and units with curiosity, openness, teamwork, energy and a willingness to fail succeed sooner and with less trauma or burnout than those not exhibiting those characteristics. Leadership of course is key in this regard.  

 

Still, that isn't enough; another essential element is data - not necessarily the most sophisticated, just enough data to objectively know if progress is being made toward the performance goal.

 

As for developing the needed infrastructure, we have multiple training opportunities for many different levels across the organization to help them employ these "change attributes," to understand the reasons for the change, and to develop competency in using tools (e.g. PDSA, basic analytics, etc.).

 

Additionally the financial, operational and analytic technical infrastructure is seeing large investments to provide the foundation for operators and providers to adapt their work.

 

Mr. Clegg: The first resource that comes to mind is great people. While having a solid strategic plan is critical, success comes from actually executing the plan. Assembling a team of dedicated professionals that are willing to work hard to achieve a goal while remaining flexible to adapt and respond to unexpected changes is the cornerstone to successful execution.

 

 

Dr. Livaudais:  Success is in seeing better patient outcomes at a population level – including “happiness”, clinical and financial. As a system, we’ll strive to be good stewards of financial and health care resources which should be reflected in better control of the total cost of care.

 

Mr. Clegg:  Adventist Health Castle broadly defines success as fulfilling our mission of “Living Gods Love by Inspiring Health, Wholeness, and Hope”. More specifically, we have a broad range of goals related to quality, customer experience and financial stewardship.  We are also spending more time than ever looking outward at the communities that we serve and are exploring how to connect in new and meaningful ways to improve health and well-being.

Q5:  As an executive leader, what is your strategy to communicate to leadership and employees about "What Payment Transformation is and how it will be successful?"

Dr. Livaudais:  Our strategy is engagement.  We certainly have numerous communication channels, but passive reception won’t drive success.  We seek to create opportunities for staff and providers to take ownership and lead the change in their areas.

Mr. Clegg:  We refer to our strategic plan as our “playbook”. Inside the playbook we outline each of our key initiatives (such as care transformation, payer strategies, etc) along with the applicable goals, list of team members, and other relevant data. The playbook is updated on a regular basis and shared with our leadership and our associates. Additionally, during each of our monthly leadership meetings one of the initiatives from the playbook is presented by a department director that is working on that specific initiative. This gives the entire leadership team an opportunity to learn about all of our key strategies throughout the year.