Five Questions for Change Healthcare's Chris Simpkins and Dr. Andrei Gonzales

By Claire Thayer, March 29, 2019

Recently, Change Healthcare’s Chris Simpkins, Vice President Value Based Analytics and Dr. Andrei Gonzales, Assistant Vice President, VBR Product Management, participated in a Healthcare Web Summit webinar and shared some of the many ways in which episode analytics can be used by Managed Medicaid plans to drive improved care quality and lower total costs of care. 

If you missed this informative webinar presentation, “Creating Value Based Payment Success in Managed Medicaid Through Analytics,” we invite you to view a PDF version of the presentation! To do so, go to: www.healthwebsummit.com/changehealthcare031419.pdf.

After the webinar, we interviewed Mr. Simpkins and Dr. Gonzales on five key takeaways from the discussion:

1. Tell us more about Change Healthcare's recommendation to starting a Value-Based Payment Program with an upside only financial incentive and then gradually move toward an upside / downside program at a later stage?

Chris Simpkins: A value-based payment program should be approached as a crawl walk run process.  Historically, payers and providers have been on opposite sides of the negotiation table.  For one side to win… the other side needs to lose.  Value based payment programs are a shared success & responsibility program. Payers and Providers will win or lose together.  This new collaborative relationship needs time to grow and develop trust. 

Health plans need time to be more comfortable sharing data with providers about what happens outside their offices.  Providers need time to be more comfortable understanding the new financial models (i.e the the rewards & risks of these programs).  Upside only programs allow payers and providers the time they need to focus on their collaborative relationship and the structure of the program without the fear of harsh downside penalties.  As the relationship grows and provider gets more comfortable with how to succeed, downside risk can be introduced.

2. Your discussion illuminated opportunities to leverage episodes in a Medicaid population, and in particular, pregnancy management. How is a Pregnancy Program similar to procedural bundles (i.e., Total Joint Replacement)?

Chris Simpkins: Pregnancy is like a procedural bundle because a large portion of the services within the episode are predictable and clearly related to the underlying trigger event.  Each episode includes prenatal visits, ultrasounds and delivery costs.  This consistency in services allows payers and providers greater accuracy in setting budgets for performance tracking and shared savings programs.  This consistency also allows you to conduct peer to peer comparisons which helps identify variations in care that can lead to higher costs and lower quality.

3. What are some of the key findings from your recent payer survey as to drivers leading Value Based Care program care adoptions? 

Dr. Gonzales: Based on our most recent research we identified four key factors driving payer interest in value-based care programs.

1)      Medical Cost Savings – Payers identified an average medical costs savings of 5.6% from the their VBC Strategies

2)      Care Quality Improvements – 77% of payers responded felt their VBC programs were either improving care quality

3)      Improved Patient and Provider Engagement – More than 64% of respondents noted that their VBC efforts were improving key stakeholder engagement

4. In your experience, what are the top 3 provider engagement challenges in episode of care management?

Dr. Gonzales: Payers continue to struggle to secure provider support for their episode of care programs.   The top three provider engagement challenges identified include:

1)      Gaining agreement on contracted budgets and risk/gain sharing

2)      Gaining agreement on episode of care performance metrics and reports

3)      Engaging providers to consider participating in an episode of care contract 

5. Can you tell us briefly about ways in which population differences between Medicare, Commercial and Medicaid require different approaches with Episodes of Care?

Chris Simpkins: These three populations have very different healthcare needs and access the healthcare system in different ways.  The Medicare population is older and accesses the healthcare system for procedural (i.e. Joint Replacement) and Acute (Stroke, AMI).  55% of Medicare dollars are spent treating these conditions.  The Medicaid population is younger, lower socioeconmic and more female.  This produces higher medical spend for Maternity care, Chronic diseases such as Ashtma, ADHD, Diabetes.  Very little is spent on procedural episodes.  These chronic diseases are not as well suited for an episode program with a fixed budget for treating a single condition.  Total Cost of Care models centered around a PCP that focus on comorbid conditions are better suited for treating these types of conditions.  The Commercial population blends the two, there are procedurals in the older portions of the population (e.g. 55-64), maternity costs for young working families and also Chronic diseases that are prevalent in all populations.