‘COVID has actually amplified the reason for value-based care’

For all of the challenges the pandemic has posed for the industry, many executives believe there’s at least one silver lining: a greater emphasis on the need to adopt new payment and Dr. Penny Wheeler, Tom care delivery models. president and CEO at Allina Health, and Lindquist, CEO of Allina Health-Aetna, a joint venture between those two organizations, spoke with Modern Healthcare Managing Editor Matthew Weinstock about efforts to sustain value-based care and drive more innovation. The following is an edited transcript.

MH: What are you doing to try to encourage patients to return for routine care? Tom, can you talk about your members, particularly seniors?

Lindquist: The senior population is nervous and for good reason. We’ve partnered with Dr. Wheeler and Allina Health to do some podcasts and (put out) information to make sure people understand how important it is to get in for that care. But in addition to that, we’re sending out convenience packages to our seniors that include thermometers, masks, hand sanitizers and all the things that they will need to help them feel safe, if a virtual visit is not for them, to get in and seek the care that they need.

Wheeler: The concern is very real. We’re seeing a 40% decrease in the number of people who are coming in for care with stroke. I don’t think the stroke rate has gone down, and I heard

from a colleague just the other day, that had a patient with four days of abdominal pain who didn’t come in and had a ruptured appendix.

We’re seeing complications that we didn’t use to see before. To Tom’s point, one, is assuring people they can get care safely. Part of it’s a fear of the unknown. (For some patients), our first approach is by telemedicine and that’s a new forum for many people. Part of it’s a concern about safe practices and care, and are they at risk if they come in? And we worry about the economic pressures on people— related to the virus and beyond—that they’ll avoid care because of concerns about payment.

We’re trying to work toward value-based payment and make things more affordable.

But for all those reasons, we firmly believe that avoided care is not safe care and that’s a concern right now.

MH: If you’re seeing that with something as serious as stroke, how do you message to people that “You have to come in and get the proper care”?

Wheeler: Many organizations have been adaptive. We went from 50 virtual visits a day to four to five thousand a day during this, but what we’re doing now beyond that is being more proactive. We’re reaching out to people who had a scheduled cancer surgery, but didn’t come in for it or who have a chronic illness and are at risk for perhaps a stroke because of hypertension or something. So we’re reaching out to those people at greatest risk.

Lindquist: We’re doing the same thing. We have the benefit of partnering with Allina and having not just the real-time data, but historical information. We’re doing the same and reaching out to these individuals that are at risk or emerging risk and asking them to go in and see their physician, helping them schedule their appointment.

Wheeler: That’s the power of the partnership too, because we can’t tell necessarily that a hypertensive patient hasn’t filled their prescription.

MH: Looking at the rapid adoption of telehealth, what are some of the limitations you are seeing?

Wheeler: Not all visits (can be done virtually). Where you need intense physical exams, some extra lab work, some procedural work, that doesn’t work. The other thing that we don’t want to happen is have deepened disparities. There are some people who don’t have access to broadband in some of our greater Minnesota areas, for example, or in some communities. Sometimes the platform, itself, or access to the platform is a barrier as well.

Lindquist: The access to broadband is a problem for some of our members and patients. I think the other side of that is that the technical barriers that

the payers and the providers are facing as well. There’s been an explosion, and so, as new solutions are coming in, we have to integrate those with our existing systems. Sometimes those systems are a little antiquated.

We’re dealing with a little bit of a silver lining as it relates to COVID because we’ve seen an explosion of innovation in healthcare, which is so overdue and much needed. With that, comes the technical challenges behind the scenes of integrating all of this into the system so that you have that continuity of care, and you don’t have gaps; a potential issue is a member or a patient calls in for a televisit, but it’s not connected to anything.

And so you potentially lose that continuity of care. All of these are our issues that we’re working with our own systems and our partners to solve as quickly as possible.

MH: On the drive to value-based care, Allina Health has the relationship with Aetna and you recently expanded one with Blue Cross and Blue Shield of Minnesota. Has COVID affected metrics you have in place for those?

Wheeler: We’ve had to look at some of the arrangements and rejigger them a little bit based on the pandemic. But the other thing that the pandemic has done is it’s shown us the value of things that would be perpetuated under value-based care.

For example, we have teleaddiction services now, and many people who are struggling from addiction sadly more than ever before with the isolation of the pandemic are just loving the services that are brought by the whole care team, into their home. And because of stigma and other reasons, they haven’t come in.

A lot of these things that we’re learning will actually be more valuable and more readily available in a value-based care model. And if anything, COVID has actually amplified the reason for value-based care, to allow for things like (hospital at home) and tele-addiction and mental health services.

“We’re seeing a 40% decrease in the number of people who are coming in for care with stroke. I don’t think the stroke rate has gone down.”

MH: Tom, have you started to rejigger some of your contracts?

Lindquist: You know what your current levels of utilization are. You also know what they were expected to be. And so that’s where the relationships and partnerships come in. Have an open, honest discussion about what’s happening and how that impacts the details of the specific arrangement that you have. The bottom line is that valuebased care is the future.

And frankly, the pandemic has, to Penny’s point, shined a light on some of the opportunities we have around improving outcomes.

We’ve talked about telemedicine and we talked about the partnerships and we’ve talked about innovations that are coming through as a function of this pandemic—building all of that into improving outcomes for individuals and improving health for populations and lowering costs, I think everyone wins.

MH: As you look toward 2022 and beyond, do you have to start with a whole fresh baseline of metrics because of the pandemic?

Lindquist: You’re not starting with a fresh baseline. You’re adding some new metrics in—things like the telemedicine visits. Take a look at your utilization and say, “OK, we were at this level, now we’re down.” Maybe one of the new metrics is getting (patients) back in to see a physician. ●