Tim Gronniger on Challenges With Implementing New Payment Models

Tim Gronniger, MPP, MHSA, senior vice president of development and strategy at Caravan Health, discusses the struggles that organizations face when attempting to make a switch to new payment models, and how that switch can be improved in the future.

Transcript

What have been some of the biggest barriers for organizations trying to implement new payment models?

Relationships within an organization and with physicians in the community are one of the first things that you have to figure out, and a lot of that comes up under the rubric of governance structures. Who’s going to be making the decisions about the ACOs performance, and who’s going to be making decisions about who’s doing what about who the leaders of it are? And, then, technology ends up dominating a lot of discussion time as well. How are we getting all of our information in one data warehouse if we’re building an ACO with our independent community network of physicians? Then, there might be 50 EMO products in that network, so we have to find a way where can at least pull data from that set of vendors, if not, push and pull that data. So, getting a good handle on IT and technology and analytics takes a lot of time early on in an ACO.

What changes do you think need to be made to improve the move to value-based payment models?

The changes that we need to see are really consistent policy direction from Washington around what they want the health system to do first. A way to enable providers who are working together on improving quality in trackable form ensure, that is going to continue into the future and avoid unforced errors, such as cancellation of a mandatory bundle payment programs last year, anything that would upset the Applecart in terms of the Medicare Shared Savings Program, where we could see a huge withdrawal if the agency moves to promote risk too aggressively. Now, I said earlier, we all know that risk-bearing models are the future and Medicare Shared Savings Program, but trying to make the future happen in 6 months is a recipe for confusion and turmoil, not a recipe for success. I’m all for the agency being aggressive on risk-bearing models, but it needs to be done in a stepwise fashion.