Private Players Launch Value-based Task Force

Two days after HHS unveiled significant Medicare payment reforms, a group of commercial payers, providers, and industry partners says it is committed to putting 75% of its business into value-based models by 2020.
Two days after HHS unveiled significant Medicare payment reforms, a group of commercial payers, providers, and industry partners says it is committed to putting 75% of its business into value-based models by 2020.<br />Some of the nation's largest healthcare systems and payers on Wednesday launched the Health Care Transformation Task Force, with an ...

Some of the nation's largest healthcare systems and payers on Wednesday launched the Health Care Transformation Task Force, with an ambitious commitment to put 75% of their business into value-based models by 2020.

The task force describes itself as a "private sector alliancededicated to accelerating the transformation of the U.S. health care system to value-based business and clinical models aligned with improving outcomes and lowering costs."   Members include commercial payers, providers, and partners.

The announcement comes just two days after Health and Human Services Secretary Sylvia Burwell announced plans to ramp up Medicare payment reforms featuring alternative payment modelsand value-based payments.

Richard J. Gilfillan, MD, CEO of Livonia, MI-based Trinity Health, is chairman of the task force, which he said is "committed to rapid, measurable change both for ourselves and our country that will improve quality and make healthcare more accessible for all American families."

Gilfillan spoke with HealthLeaders Media on Wednesday about the task force and the goals and challenges it will face in the coming months and years. The following is an edited transcript.

HealthLeaders Media: What is your biggest concern about the value-based care rollout and how can your task force prevent it from happening?

Richard Gilfillan: My biggest concern is that as an organization we don't get there in a timely way because we find ourselves having to respond to the pushes and pulls from all directions as opposed to a clear and smooth path forward.

My concern from the broader perspective of the industry is that this is an incredible time and a great opportunity to get to where we all want to get to. I'd hate for us to miss the opportunity because we can't find a way to make it happen, and this kind of cooperation in setting goals and working together really gives us an optimal chance to transform our care system.

HLM: Are you concerned that the value-based rollout could become as disorganized as the HIT rollout?

RG: I wouldn't want to come off as being critical of that specific issue and segment of the industry. From a provider standpoint I am concerned, and I used to be in the payer business as well. I know that we all—whether providers, payers, or employers, or advocates for patients—have our ideas and we think they are the best and only way.

This is hard work for providers and payers making this big transition. If we are pushing and pulling on 10 different paths to how we see it and what we think the timing should be, it's even harder.

People will find themselves in this hedging scenario, one foot in the canoe and one on the dock. If we could get some commonality around time frame and consistency of approach then it is very doable.

HLM: Are you on the same page as HHS at this point on the value-based rollout?

RG: Secretary Burwell talked about two sets of metrics. One was for gauging the extent to which their payments are operating under these alternative contracts, which they defined as medical homes with triple-aim outcomes, bundled payment programs, ACO programs. That aligns directly with our thinking about our 75% commitment.

They also talked about how many of the dollars would be operating under the value-based payment systems, which is more the incentive-type arrangements that don't necessarily have total cost of care included.

I understand that they needed to pay attention to that space. We are well-aligned in terms of the goals and the definitions. Hopefully, we'll find that as the industry comes together to develop the best ways to get at that and define those models in more detail, that is where we will influence each other and come to an approach that works.

We would like to work with HHS and CMS to do the most we can to create a synergistic approach. There is a lot of potential for building momentum in the private sector as well.

HLM: Why do you believe this transition should be "rapid?"

RG: We have found as we have talked to other providers that it's really hard to operate in two or three different ways. At first everyone said, 'let me try a little alternative contracting, a little responsibility for total cost of care and better outcomes, but I want to keep my old way of doing things too.'

People realized that the halfway world is very difficult and disorienting for an organization and its people. That period of uncertainty, mixed messages, and confusion, is painful. Many of us have said, 'let's find our way to that sooner and be on a specific path so we can communicate in a straightforward way with our organization and people.'

We want to give them a clear message and a path forward and a sense of where we are going so that we can plan that out and execute on it in a logical thoughtful way. Most of us feel that it's better to do it sooner rather than drag it out into an extended period of uncertainty.

HLM: So the mindset now is that this is going to happen so we might as well get it done?

RG: I think so. The other thing we are realizing is that it's not just about cost, or quality, or health. It's about all three. Nobody went into healthcare to deliver fragmented, uncoordinated, inaccessible, and unaffordable care. This is actually taking us back to why we went into healthcare. It's exciting. Let's get there sooner rather than later. The country needs this sooner rather than later from a lot of perspectives.

HLM: Did the timing of the HHS announcement on Monday affect your announcement?

RG: Our first meeting was in June and we were reaching out to people two or three months before that. This is almost a year's work getting to this point. People in Washington have talked about there being a timeline from the federal government since 2009.

We heard from the secretary's office a week and a half ago that there was going to be some announcement. They were putting a stake in the sand. We were invited to be part of an initial information session and then we were invited to join the secretary at the announcement.

We realized this is very much on a parallel track and one that works. It's a great coming together of people's thinking about what it would take to be successful.

HLM: Do you anticipate more disagreements within the task force as you address more specific details on how value-based care will work?

RG: The answer is yes. We do anticipate differences of perspective. The reason we need to do this is because there are multiple perspectives and those perspectives are different among providers and payers and across those groups.

We have already done some hard work in talking through those differences and creating what we think is a preferred set of principles and policies.

Our most immediate effort is going to be to provide comments in the episode-based payment space and in ACOs and we are working on that now. So yes, there will be differences, but that is the purpose of this.

We have to listen to each other and understand each other's perspectives and this task force creates a context in which we can actually do that. We hope we can provide input for CMS along the way.

HLM: How did you come to decide upon 75% in value-based by 2020?  

RG: We knew that one of the key goals here was to put a stake in the ground that we all had to agree to and 75% and five years seemed reasonable.  

HLM: How will the task force spend its time over the next few months?

RG: Organizationally, we just launched publically and we are still putting the logistics in place to operate the task force. It's been up and operating, but we are trying to understand the best way to engage as many people and organizations as possible, so we are working through the best way to do that, and respond to what we see as a lot of interest.

There are a lot of people who are interested and I hope between this and the HHS announcement people will see it's a good time to make that commitment organizationally.

HLM: Do you expect the task force to take on new members in the coming years?

RG: This is about folks coming together who hope and expect that others will be interested in signing on and working on this goal. I am already getting a fair number of inquiries from folks saying they'd like to be involved.