The Kinetix Group (TKG) had the honor of hosting its second annual Health Systems Advisory Panel in conjunction with the AMGA Annual Conference on March 24th in Dallas, Texas. The panel, which featured five esteemed healthcare leaders and experts from premier health systems and medical groups, was moderated by Len Fromer, MD, and covered key healthcare trends and health system goals in 2017, namely the Movement to Value-Based Care and Pharmaceutical Products in a Value-Based World. TKG also hosted the Welcome Reception at the conference, which was attended by nearly 2,000 conference attendees.
As part of the TKG value service model, below are the key takeaways from the discussion.
The Movement to Value-Based Care
Panelists provided an overview of the challenges faced by medical groups and health systems in moving to value-based care, which has been accelerated by the establishment of the Quality Payment Program legislation to measure quality and cost metrics by 2019.
- WHAT IT MEANS: The move to value-based and outpatient care is distinctly difficult depending on the structure and organizational culture of provider groups. Health systems and medical groups are looking to deliver value, while also increasing revenue and maintaining market share by focusing on alternative payment models in the specialty care space, utilizing extended care teams to improve patient care, and actively addressing the cultural shift needed to successfully deliver value.
- WHAT OUR EXPERTS HAD TO SAY:
“There’s a lot of interest in MACRA and how to get out of MIPS by getting into APMs, and the focus is coming out of specialty work as opposed to primary care.” – Large IDN, Northeast
“Once you demonstrate to the care team what a bundle looks like, it fundamentally changes the way physicians practice medicine.” – Large IDN, South Central
- WHAT PHARMA CAN DO: The most efficient way to break down siloes between health system and medical group stakeholders, health plan stakeholders, and pharmacy decision-makers is to move the discussion to value. As a result, provider groups are taking a more holistic approach to formulary decision making, and the pharmaceutical industry has an opportunity to demonstrate total cost of care and the overall patient experience.
Pharmaceutical Products in a Value-Based World
Health systems and medical groups face many barriers in contracting with pharmaceutical companies due to competing players in the decision-making process, with different key stakeholders driving patients to different products.
- WHAT IT MEANS: Specific challenges that were covered included the deterrence of product use because of tedious physician approval processes, doctors prescribing based on discounts from payers for specific products, and strong preference for generic products over branded rebates.
- WHAT OUR EXPERTS HAD TO SAY:
“You have to show what the value stream looks like for a patient experience…total cost versus episodic costs should be taken into consideration” – Large Health System, Southeast
“Pricing must include ROI for the providers; otherwise, physicians have to go through a prohibitive approval process.” – Large Multi-Specialty Group, Northeast
- WHAT PHARMA CAN DO: To expedite the physician approval process for product use, pricing must include ROIs and risk-based contracts. Drug development needs to be innovative and prove secondary benefits for greater formulary placement. Coordination with internal leadership is essential, and it is important to target stakeholder groups that are already working with pharmaceutical risk-based contacts.
This year’s Health Systems Advisory Panel proved another great success, with panelists providing candid commentary on the challenges ahead in the health care industry’s shift to value-based care. In future blog posts, we will dive deeper into best practices discussed during the panel.