Tran­si­tion­ing To Value-based Health­care Is Well Worth The Ef­fort

Sup­pli­ers and providers are suc­cess­fully col­lab­o­rat­ing to bring more value to pa­tients and the health­care sys­tem

Modern Healthcare - - Regional News -

Mike Coyle Ex­ec­u­tive Vice Pres­i­dent and Pres­i­dent of the Car­diac and Vas­cu­lar Group, Medtronic

As health­care providers pre­pare for an evolv­ing en­vi­ron­ment that’s shift­ing away from a fee-for-ser­vice model, they’re em­brac­ing new ways — and es­tab­lish­ing new part­ner­ships — to drive bet­ter value and pa­tient out­comes. Mike Coyle of the Medtronic Car­diac and Vas­cu­lar Group has over­seen the de­vel­op­ment of six com­mer­cial­ized Value-Based Health­care (VBHC) pro­grams and knows a thing or two about the com­plex­i­ties of im­ple­ment­ing VBHC. He shares his per­sonal in­sights, as well as what he’s heard first-hand from cus­tomers.

What in­sights have cus­tomers shared about their ex­pe­ri­ences adopt­ing VBHC?

MC: I’ve gleaned from our cus­tomers that tran­si­tion­ing to VBHC is not an easy task, and it takes time. They’re learn­ing that VBHC re­quires in­vest­ing in data and tal­ent to pre­pare for new pay­ment models and reg­u­la­tions. With that said, providers see the chang­ing land­scape — one mov­ing away from fee-for-ser­vice — with clar­ity. VBHC pro­grams pro­vide them the op­por­tu­nity to ad­just to these changes in a tan­gi­ble way.

Medtronic is chang­ing too, and VBHC is a big part of our trans­for­ma­tion. In ad­di­tion to de­vel­op­ing prod­ucts that de­liver strong pa­tient out­comes and eco­nomic value to the health­care sys­tem, our goal is to help our cus­tomers make the most in­formed de­ci­sion about the value of this tech­nol­ogy.

How are you us­ing clin­i­cal and eco­nomic data to guide your VBHC strate­gies?

MC: Foun­da­tional to any suc­cess­ful VBHC pro­gram is a deep knowl­edge of the clin­i­cal and eco­nomic out­comes that a so­lu­tion brings to a pa­tient co­hort. In fact, our risk-share pro­grams hinge on our abil­ity to de­liver su­pe­rior clin­i­cal out­comes and eco­nomic value. Of­fer­ings like our TYRX and SmartShock risk-share pro­grams are de­signed to put our money where our mouth is — if the ex­pected pa­tient out­come isn’t achieved, we pay the provider.

When de­vel­op­ing VBHC strate­gies, we first rely on strong clin­i­cal data to base­line the clin­i­cal out­comes we ex­pect for a pa­tient pop­u­la­tion. Then, we study these pa­tients in claims data to un­der­stand the eco­nomic im­pact this clin­i­cal ben­e­fit could have on a real-world pop­u­la­tion. This process helps us de­ter­mine where and when to im­ple­ment new risk-share pro­grams. Along­side these strate­gies, we’ve in­vested in data as­sets from many sources, in­clud­ing Op­tum, to have a bet­ter lon­gi­tu­di­nal un­der­stand­ing of the cost of our ther­a­pies.

What lessons have you learned about op­er­a­tional­iz­ing VBHC pro­grams?

MC: Our cus­tomers are be­gin­ning to in­te­grate their op­er­a­tional costs to­gether with pa­tient claims costs to cre­ate a ro­bust view of where op­por­tu­ni­ties lie for im­prov­ing pa­tient out­comes. But as they do this, I’ve heard a com­mon is­sue around hospi­tal data sys­tems; sys­tems that weren’t orig­i­nally de­signed to gen­er­ate the an­a­lyt­ics needed for VBHC. Work­ing with im­per­fect and siloed data to fol­low pa­tients along an en­tire care path­way can be ar­du­ous. Shar­ing in­for­ma­tion ex­ter­nally can also be a chal­lenge, given much of it is pa­tient health in­for­ma­tion (PHI).

While it hasn’t been an easy tran­si­tion, in­te­grat­ing data is a nec­es­sary step to un­der­stand­ing the clin­i­cal and eco­nomic out­comes as­so­ci­ated with a VBHC pro­gram.

I’ve seen more cus­tomers build­ing their data ware­house ca­pa­bil­i­ties and suc­cess­fully lever­ag­ing that data to iden­tify ar­eas for care im­prove­ment. These or­ga­ni­za­tions’ abil­ity to cre­ate broad so­lu­tions for data con­nec­tiv­ity will have a pos­i­tive ef­fect on the ac­cel­er­a­tion of VBHC.

Have you seen VBHC man­age costs and im­prove pa­tient out­comes?

MC: When you can re­duce the num­ber of pa­tient in­ter­ven­tions and re­duce a pa­tient’s vis­its to the hospi­tal, that de­creases costs while cre­at­ing a more pa­tient-cen­tric ex­pe­ri­ence. That’s what VBHC is all about.

To give a real-world ex­am­ple, we have a risk-share pro­gram for our TYRX ab­sorbable en­ve­lope — a prod­uct that can help re­duce the in­fec­tion rate for pa­tients re­ceiv­ing an im­plantable de­vice, like a pacemaker. We know that ev­ery time a de­vice-re­lated in­fec­tion is avoided, the pa­tient is hap­pier, and the payer saves around $57,000. That’s a sig­nif­i­cant im­pact on over­all costs.

The adop­tion of VBHC has also in­creased aware­ness around the long-term clin­i­cal and eco­nomic ben­e­fits of prod­ucts and ther­a­pies, which I be­lieve re­sults in a bet­ter over­all ac­count­ing of the fi­nan­cial im­pli­ca­tions that med­i­cal de­ci­sions place on the health­care sys­tem.

All of our ther­a­pies play a role in al­le­vi­at­ing pain, restor­ing health, and ex­tend­ing life. VBHC com­bines this with ac­tion­able clin­i­cal data that demon­strates how these ther­a­pies can drive more ef­fec­tive, ef­fi­cient-care. That’s a win­ning recipe.

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