Health equity is achieved when every person can achieve his or her full health potential, irrespective of socioeconomic status, race, ethnicity or other social circumstances. It requires support from the overall healthcare system, local providers, community resources and patients.
But there’s one small issue: the fee-for-service (FFS) model, which remains the predominant payment model today (although shifting), undermines equity. By responding to sickness as opposed to health, providers are not properly incentivized to develop systems that promote total wellness prior to a health episode or development of chronic conditions.
To reverse this imbalance, alternative payment models (APMs) – including accountable care organizations (ACOs) and bundled payment models – are increasingly incentivizing providers to proactively and better manage care for a defined population.
In April 2021, Premier hosted a provider panel diving into how participation in alternative payment models has unshackled providers from the constraints of FFS and enabled innovation that improves patient care and access.
And recently, we took the conversation a step further to delve into how participation in ACOs and risk-based arrangements have enabled them to change their approach to patient care and work with their communities, thereby making care delivery more equitable.
One standout point was the importance of population health data to fuel the development of valuable resources and higher-performing network partners.
Here are three ways providers are using data to advance health equity.
1. Enabling insights into patient needs and how and when care is being accessed – fueling a multi-disciplinary approach to care.
Providers in APMs have a better sense of where their patients are in their community, how they interact with the healthcare system and what gaps are exacerbating health conditions.
Ruth Krystopolski, Senior Vice President of Population Health at Atrium Health, shared that broader data sets allow for thoughtful program and service development. As an example, she explained how Atrium Health uses data to stratify patients into risk bands and then focus resources on those most in need.
Applying this methodology to high utilizers of the emergency department, Atrium measured a 40 percent year-over-year decline in cost and ED utilization. When the system applied the same framework to its high inpatient admissions population, it observed a cost reduction of more than 30 percent.
Atrium Health also leveraged COVID-19 testing and vaccination data to understand access gaps and deployed mobile-based testing and vaccination units in underserved areas.
Joyce Leon, MD, Medical Director of Population Health Management at Henry Ford Health System, spotlighted how APMs uncover data insights that allow her team to think outside of traditional patient care teams and care delivery sites.
Henry Ford developed a mobile integrated health program, and Dr. Leon noted there was “no CPT code for mobile care, so no architecture or construct for us to bill this, but it was necessary for our patients.” The mobile unit has served more than 1,500 unique patients, resulting in ED avoidance in 30 percent of cases.
Uncovering data insights has supported populations beyond the APM. Henry Ford has narrowed disparities in care for a predominantly black population in Detroit through use of school-based clinics. Expanding the clinics from servicing students and their parents to being a resource for the entire surrounding community, helps ensure that the entire population can receive accessible care.
“Data reveals profound inequities,” said Frederick Isasi, Executive Director of Families USA, who underscored the need for a rich data environment in order to undo a system that for decades has left people behind.
2. Fueling development of high-value networks that result in tens of millions of dollars of savings, reduced readmissions and better outcomes.
APM data enables providers to link cost, quality and outcomes data to identify the highest-performing skilled nursing facilities (SNF) and home care providers in their footprint, helping patients select the best sites for post-acute care.
Richard Shuman, MD, CEO of Baycare Health Partners, a four-hospital system in western Massachusetts, noted that his SNF network agreed to specific performance criteria, resulting in a preferred SNF network with consistently high performance for length of stay.
Similarly, Baycare’s care management program boasts a net promoter score of greater than 80 percent from patients. He emphasized how the shift in care from the ED to the home has resulted in significant cost avoidance.
3. Laying the foundation for a social impact strategy and propelling modern-day community resources off of which providers can piggyback.
Risk stratification is nothing new, but providers are increasingly using their data on patients’ risk factors to link them with community resources, working more wholly to advance access and prevent unnecessary utilization.
Carrie Nelson, MD, Population Health Leader at Advocate Aurora Health (AAH), explained how AAH has partnered with a community organization that has fully mapped out community resources – “things traditionally kept on Excel spreadsheets and quickly outdated,” she added.
AAH leveraged its screening program to understand the community resources that patients can access and details important to them – whether it's copay, languages spoken or bus routes – enabling the most valuable use of this tool. The work has led to an 11.6 percent decline in ED utilization for patients who were screened and referred to the programs.
Krystopolski noted that Atrium is using APM data to underpin its overall social impact strategy. The system’s goal is to eradicate disparity and mortality, beginning with hypertension – a goal that could only be measured with data from its APMs.
Families USA’s Isasi spoke to the power of APMs to redistribute capital across organizations. “What we see in those models with respect to community engagement is that the community table is set - the health systems, payers, community-based organizations, behavioral health, sometimes corrections, housing organizations - all of those groups come together around a community table.” When these groups are working together you can rethink how the total capitated payment is distributed.
Data is enabling provider innovation, diverting them from the FFS chassis and spurring creative solutions that advance health equity.
In the march toward health equity, Premier is enabling best practice sharing in our collaboratives and advocating for equitable health policy that advances value-based care and reduces barriers to interoperability to improve data collection and enhance real-time outcomes.
Action by Congress and the Biden administration can help accelerate these advancements and further close care equity gaps:
- Continue financial incentives for all providers to move towards APMs and create greater incentives for medical specialists to engage in APMs
- Ensure adequate financial support for providers and health systems to move the place of service to the most appropriate setting
- Concentrate on fewer models with a stronger emphasis on total cost of care APMs
- Unleash data that is ubiquitous and available to providers, policymakers and researchers
- Advance data interoperability and standards for social determinants of health
Stay up to date on how we’re using data to advance our members’ capabilities and propel healthcare innovation.