Stellar Health (“Stellar”) and the Primary Care Development Corporation (“PCDC”) today announced a partnership designed to help primary care providers thrive in the current value-based care world. Stellar, a value-based healthcare technology company, empowers practicing physicians and their care teams through a point-of-care platform that provides real-time actionable insights and meaningful financial incentives to drive improved patient outcomes. PCDC, a national non-profit, provides financing, on-the-ground training, and technical assistance, specifically designed to support the sustainability and performance improvement of primary care providers across the country. Together, Stellar and PCDC recognize the important role that primary care providers play in the nation’s shift to improve quality, reduce costs, and increase access to care.
Zack Caplan, Head of Provider Network and Strategy at Stellar Health, and Isaac Kastenbaum, Vice President of the Training and Technical Assistance practice at PCDC, sat down to discuss the importance of value-based care and the new collaboration between both organizations. You can also read the Q&A on PCDC’s website here.
1. Has the COVID-19 pandemic accelerated the shift to value-based care?
Zack: The current fee-for-service model has meant that healthcare providers, including independent primary care practices and community health centers, have seen a significant drop in revenue due to patients delaying or avoiding standard medical care during the pandemic. Since most primary care revenue comes from in-person visits, this increased financial pressure has led practices to (1) consider closing their doors (temporarily or permanently) or (2) seek new opportunities for financial stability. Value-based care models may offer a path for primary care groups to maintain their independence, while expanding (or at least flattening) their cash flow through more advanced contractual arrangements. Advanced value-based payment structures, such as capitation, can offer a fixed monthly payment for primary care providers. Even if a provider isn’t ready for full capitation, other value-based payment structures such as partial capitation, fronted quality bonuses, or other prospective payments can help providers manage the volatility of the pandemic, while remaining focused on patient care.
Isaac: Anecdotally, health plans are seeing increased interest in their value-based programs by primary care providers; however, not every organization is immediately well-suited for the change in reimbursement model. There has also been a pandemic-concurrent release of new programs from CMS to encourage this transition, including the Community Health Access and Rural Transformation (CHART) model, the Geographic Direct Contracting Model (“Geo”), and the Direct Contracting Model.
2. What barriers are there for primary care providers to succeed in value-based care?
Zack: Success in value-based care takes appropriate levels of staffing, technology, access to data, and other costly resources that independent primary care providers often don’t have the financial ability to invest in. The industry asks providers to make these upfront investments in infrastructure without knowing whether they will receive any return on those investments through additional value-based payments until the end of the year. Providers are therefore forced to often find ways to try to make due with existing resources. Everyone in the industry likes to ask providers to “just spend an extra five minutes” on value-based care activities. While primary care providers wish they could spend that extra time with their patients, each five minutes spent is one-third less of a 15-minute office visit that they can do that day and, unfortunately, their financials are highly dependent on their daily patient volumes.
Isaac: Other barriers include equipping non-clinical team members to be part of providing quality care, ensuring practices have the capacity to consume and analyze plan-provided data, increasing practices’ understanding of risk-adjustment, the implications of sound billing and coding practices, and the need to efficiently navigate the specialists and acute care facilities with whom they collaborate. Providers must also manage the significant delay until they see shared savings or quality incentive payments; these are primarily calculated retrospectively and checks may not come until six-to-eight months following the contract period.
3. What types of incentives are there for providers within value-based care?
Isaac: The obvious incentive is the perceived additional dollars that might flow to a practice. These may come due to “shared savings” (where practices share in any reductions in total cost of care for their attributed patients) or “quality incentives” (where additional funds are available for exceeding pre-determined quality thresholds). Providers may also consider a capitation model where they’re paid a predetermined, risk-adjusted monthly amount for each of their attributed patients – while not necessarily additional revenue upfront, this does offer the opportunity for a more predictable revenue stream. Depending on the health plan contract and state, providers may also be eligible to receive additional payments for achieving practice standards (e.g. NCQA Patient-Centered Medical Home), for providing care coordination activities, or for other administrative efforts.
Zack: Most providers are actually leaving existing financial incentives from health plans on the table. Health plans often announce in the press the amount of value-based dollars their providers are eligible to earn, but the truth is that most providers only earn a fraction of these incentives each year because of structural issues in the way they’ve been contracted. Let’s say there is an incentive that if the provider gets over 70% of their 100 eligible patients to get breast cancer screenings, then they earn an extra $10,000. However, if that provider only got 20 of their 100 patients to complete the screening the prior year, and then works really hard and gets 60 out of 100 this year – they got 40 more women to get important breast cancer screenings (!) but they somehow still earn $0 since they didn’t reach the 70% threshold. Providers should look to their insurers not just for net-new revenue opportunities, but also for better alignment on existing incentive structures.
4. How can Stellar Health’s platform help independent providers achieve their value-based care goals?
Zack: Stellar Health convinces health plans to offer upfront capital, free technology, and support to help primary care groups on the path to more advanced contracts. Stellar drives providers to get paid extra on top of their existing reimbursement for completing value-based activities, some of which they are already likely doing, but not getting paid for, such as calling patients to schedule appointments or reminding them to pick up their medication. Stellar’s web-based application engages the whole practice, empowering care teams to complete high-value activities that enable providers to focus on caring for the patient in front of them. The Stellar Application eliminates the variety of payor-specific spreadsheets and dashboards that often overwhelm practices and instead creates one central workflow for managing patients, regardless of their health plan. Providers can also track how much extra they’ve earned through the program in real time, so they can avoid any end of year surprises.
5. What can PCDC do to enable independent providers to achieve their value-based care goals?
Isaac: PCDC’s training and technical assistance staff are available to support practices in identifying opportunities to engage all care team members in meeting patients’ needs and maximizing value-based care payment, to optimize the use of EHRs and other technology, to work through workflows and referral pathways with other providers and social service entities to address patients medical, behavioral, and psychosocial needs. The team is also available to work through the revenue cycle challenges associated with value-based care, and how best to accomplish quality goals in a highly virtual world. In addition, PCDC’s Community Investment team is available to discuss potential financing mechanisms to support the technology, staffing, and facility capital that might be necessary to be successful in value-based arrangements.
6. What can practices expect from the PCDC and Stellar Health partnership?
Zack: PCDC and Stellar Health recognize the important role that primary care providers play in the nation’s shift to improve quality, reduce costs, and increase access to care. This partnership will leverage Stellar’s technology, PCDC’s financial and consultative resources, and their combined health plan relationships to support primary care practices in their transition to operational and financial sustainability within value-based care. Stellar has been fortunate to continue to grow our provider network, and in 2020, we generated over 1M+ value-based actions in the Stellar Application. We look forward to the opportunity to expand support to even more providers in 2021 through this partnership with PCDC.
Isaac: We look forward to continuing to support providers in their transition to value-based models, especially as we see the revenue disruptions associated with the COVID-19 public health emergency and associated economic fallout. Going forward, our two teams will be looking for ways to meaningfully support practices to improve their quality and financial wellbeing and to be better positioned for continued community impact through COVID-19 and beyond.
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