How Atrius got an early start on value-based care

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Back when fee-for-service was the normal way to do business, Atrius Health in Newton, Massachusetts was already testing accountable care, according to Emily Brower, executive director for Atrius Health’s Accountable Care programs.

You have to make the investments to make the return so you can pay yourself back.

It’s that early adoption that helped Atrius get ahead, especially in lieu of Monday’s announcement by the U.S. Department of Health and Human Services that all providers will soon have to adopt a value-based care model.

[Also: HHS ramps up bundled payments]

Secretary Sylvia M. Burwell on Monday said 50 percent of reimbursements will be tied to value of care by 2018. By the end of 2016, HHS wants 30 percent of payments for traditional Medicare benefits tied to alternative payment models such as ACOs or bundled pay arrangements. Also by the end of 2016, HHS wants to see 85 percent of Medicare’s hospital payments tied to value-based payment models through programs such as the Hospital Value-Based Purchasing Program or the Hospital Readmissions Reduction Program.

We spoke with Brower about the HHS announcement.

HFN: Where does Atrius stand with these announced benchmarks?

EB: About 75 percent is under the accountable care model. This is aligned with how we’d like to see the system move.

Atrius has accountability for cost of care, quality, end-patient experience, the triple aim. We’ve been working with partners on this value-based construct. It all comes together in a way that helps us as a delivery system to be very aligned in this with those purchasing care.

HFN: Was Monday’s announcement helpful for you?

EB: I think what was helpful about yesterday’s announcement, it laid out a framework. It was helpful for delivery systems to say, ‘Where am I in this framework? What percent of my work is in that value space?’

HHS noted they have a responsibility to lead. And I think that was absolutely right and this does it in a more explicit way.

HFN: When did Atrius begin with the accountable care model?

EB: It goes back to early days of Harvard Community Health Plan working with purchases for total cost of care. In the ’90s when a lot of that got dismantled in healthcare delivery (with a focus on cost and not quality), we maintained some of that structure. We were ready when that system came back around.

While each of our Atrius Health groups continues to serve its own patients, we also act in concert to bring a broader range of needed services to our communities. All groups utilize an electronic medical record to improve care coordination and communication for patients.

HFN: Why did Atrius stay with the value model at that time?

EB: Definitely we heard from our patients about wanting to have more choice so we started with Harvard Vanguard and expanded it to include patients who chose other health plans. It was a more expansive network, everything that represented more choice for patients.

It used to be called capitation, an accountable model that has more of an emphasis on quality and patients have full choice. It felt like the right way to deliver care. I think it was in our DNA.

HFN: How difficult do you think it will be for other providers to meet HHS benchmarks?

EB: It is hard if all your eggs are in the Medicare basket. You have to make the investments to make the return so you can pay yourself back. If they’re going to invest in the gaps -- hiring nurses, coaches, whatever the population is, wherever the gaps are -- if they still have a fee-for-service chassis, they have to be strategic about those investments. Because you have to wait for those returns. It’s an investment in a non-billable service.

HFN: How long a wait is the return?

EB: For Medicare ACO models, you might not get your savings until 18 months after the start. Like any business, you have to have a balanced portfolio. Health plan partners have more of a cash flow. It’s hard if that’s your only business.

HFN: What would you suggest providers do to meet the benchmarks?

EB: A Medicare shared savings program is a way to start doing that work. What many of them have done is to get their health plan partners on board as well. I think it’s understanding where are the gaps for your population in your delivery system. It’s different for a Medicare population than kids with disabilities. You have to look at the population and where the gaps are to understand. If you feel like you can do that, then you’re going to want to be responsible for the total cost of care.

HFN: Do you think providers are paying attention to the HHS benchmarks?

EB: Every meeting I go to, this is a topic. Value is the lens now in which we do everything, whether it’s locally or in market, or whether it’s through associations. Everybody is working on this. I think five years ago, voices in the room said, fee for service works for me. I just don’t hear those voices anymore.

Twitter: @SusanMorseHFN