Modern Healthcare
So what do two icons in healthcare think has worked and what fell short in terms of collaborations over the past 45 years?
We asked Marilyn Tavenner, the former CMS administrator who spearheaded the rollout of the most significant healthcare policy of the 21st century, the Affordable Care Act, and Joseph Swedish, former chairman, president and CEO of health insurer Anthem to tell us.
What are some prime areas for partnerships?Tavenner: Maternal health and disparity issues. Does the patient have appropriate food, home care and supports? I think providers, payers, health systems, everyone has to come together to fix those disparities.
Swedish: We always used to say so goes government, so goes the healthcare delivery systems, because so much of what we do is dependent on regulations and policy. So I believe government has to take a lead that’s consistent, focused and supportive of providers and payers. We all must be committed to improving access, affordability and quality, both quality of service as well as care delivery.
How can value-based care spark successful partnerships?Tavenner: It’s a mistake we made during the Affordable Care Act. We had very talented people working in CMMI. But the idea there was: Let’s let the public and private sectors tell us what they want, and we’ll take it from the ground up. If we’re going to move away from fee-for-service, then we’re going to have to identify the priorities. I think that is best if it comes from the administration, whoever that is. We stick to three or four things, and we push them through.
Swedish: What concerns me a great deal, looking back 45 years, is that contracting between payers and providers was totally win-lose. Somehow, we created a lot of benefit and value, and quite frankly, it all went to the payer. It was all because the contracts were so peculiarly built. Now we’re striving to achieve total alignment between payer and provider so that there is a win-win. The only way we’re going to win is to pay for what we are supposed to get and don’t pay if you don’t get it. We haven’t quite figured out that equation yet.
How can private equity be a good partner?Tavenner: When I left full-time employment and started to look at board seats, I asked, “Where did we need help as an industry?” One area was post-acute care. Private equity helped develop the PACE program, which helps folks stay in the community longer. Some private equity efforts have failed, some of them have flourished and become public and are big parts of our healthcare system today. But if we didn’t have a competitive market with people who are willing to take risks because they feel like the market is closed to them, then things like post-acute care innovations don’t happen.
Swedish: Healthcare is a very ripe space for accelerated investment because you have continued cost pressures. As we said, the waste is incredible and just an escalating cost, which is unrelenting. Capital partners are essential for the provider community to grab onto in order to properly invest in innovation. So I look at the provider community and say, “OK, well, what are you going to do about repositioning yourself in the market?”
Source link : https://www.modernhealthcare.com/policy/qa-cost-driver-collaboration
