A value-based healthcare enabler explains its successful model
There are many emerging value-based care models in healthcare that are changing the definition of what professionals mean by healthcare. Equality Health is an example of a VBC success story that offers a different take on values-based models – and offers some lessons that healthcare leaders can learn from.
Equality Health bills itself as a VBC enabler with a Medicaid-first care model that provides technology and human support to independent primary care practices in underserved communities with the goal of making them successful in VBC.
The “VBC enabler” built its Medicaid-first care model and business approach on this intent: aligning care delivery incentives with patient interests to improve patient outcomes and create real value in healthcare.
Equality Health is not a supplier in the traditional sense of the word. It has technology, but doesn’t sell it to providers. It will be given away for free when primary care physicians join the Equality Health Value-Based Care Network, which now operates in five states.
Dr. Michael Poku is Chief Clinical Officer at Equality Health. We spoke with him to try to find a definition of value-based care for the entire healthcare system. We asked him to expand on Equality Health’s VBC model, explain the value proposition for primary care providers who join the Equality Health Value-Based Care Network, and highlight the results the organization has achieved for its affiliates doctors.
Q. There are several value-based care models and definitions in healthcare that are changing the definition. What do you think the definition of value-based care should be?
A. The traditional fee-for-service (FFS) system rewards volume of services over quality care and improved health outcomes.
In contrast, VBC takes a holistic approach to patient care with the goal of improving outcomes and eliminating unnecessary expenditures. So from a definitional perspective, I like to think of VBC as a model of care that emphasizes proactive and preventative care, encouraging providers to understand patients from a comprehensive biopsychosocial perspective, going beyond just their illnesses.
This approach often includes addressing additional factors, such as social determinants of health, that may hinder patients from accessing or learning about needed care.
Ultimately, VBC is a more equitable and financially sustainable model compared to FFS, although it requires greater coordination and involvement from a wider range of stakeholders.
V. Equality Health employs a Medicaid-first care model and business approach that the organization says aims to align healthcare incentives with patient interests to improve patient outcomes and create real value in healthcare. Please elaborate on this and explain how Equality Health works.
A. Equality Health is committed to transforming the current state of health care and empowering providers and health plans to focus their work on those individuals and communities who need it most. This often means focusing on Medicaid beneficiaries, the health care providers who serve them, and the health plans that cover them.
We begin by contracting with health plans around value-based care. It is important to note that – especially for Medicaid, which is largely administered at the state level – this can be complex.
Next, we recognize that both VBC and Medicaid are best delivered locally by highly committed primary care providers. They know their patients best and are in the optimal position to learn more and coordinate care. However, the average PCP serving Medicaid patients must see approximately 24 patients per day to break even financially.
This is incredibly challenging to manage with a complex patient population, multi-payer contracts, quality objectives, and infrastructure needs that may be out of reach of independent providers. That’s why Equality Health is focused on providing the support primary care physicians need, including proprietary technology that identifies patients in need of care (regardless of their insurance plan), best practices for streamlining workflow, and a financial program based on the clinical activities they perform. carry them out today.
And then we “package” the PCP’s services with support outside the four walls of the practice. Our local team of community health workers, nurses, healthcare specialists and chaplains act as an extension of the provider’s office and connect directly with patients to help them access the services they need, such as wellness and chronic care visits , facilitating transitions of care, home care, visits, care coordination, and connecting patients to food or housing.
Our goal is to improve the patient-provider relationship, always referring patients back to their primary care provider. Equality Health exists to support – not replace – the primary care provider.
Q. What is the value proposition for primary care providers who join the Equality Health Value-Based Care Network, which now operates in five states?
A. Working in primary care is a higher calling, especially for those who primarily serve Medicaid beneficiaries. These patients often have complex needs, both clinically and due to non-medical health factors. At the same time, the administrative burden of primary care has become virtually unsustainable. Equality Health focuses on both aspects of contemporary primary care.
We help providers activate VBC in a meaningful way that really works. This translates into streamlined processes, more time for patients, better results and additional financial opportunities – all at no cost to the practice. This means that we can all deliver on the ‘value’ of value-based care.
Q. What role does healthcare IT play in Equality Health’s value-based care model?
A. Our model is built around the idea that PCPs need help navigating the transition from the traditional FFS model to VBC, especially with technology infrastructure that can be difficult or impossible for smaller or independent practices to develop.
Equality Health helps practices make this transition successfully by offering the technology at no additional cost and then supporting it through its implementation and use in the office. Our solutions are focused on enabling providers to implement the change and achieve VBC success.
One of the most important pillars of our offering is our own platform called CareEmpower. It unravels what can be a very complicated VBC environment for GPs and makes it easy for them to do the work that will lead to better outcomes for their patients.
We use a wide range of data, whether that data comes from a care plan, a health information exchange, or from the practice’s own EHR. We then integrate advanced analytics to make that data simple and actionable for the providers and staff in a PCP’s office, presenting it in the form of work lists, reporting and data sharing.
Q. Equality Health reports an 11% reduction in emergency department use among patients and five-star results for patients with chronic diseases. Explain how Equality Health was able to achieve these results for its member PCPs.
A. This is best expressed using a patient example.
Let’s take a patient in her mid-40s who lives in a historically marginalized community. She may not be aware of a recommendation for colorectal screening, especially if she has previously had difficulty accessing outpatient care services.
Following a VBC model, her GP conducted a thoughtful patient interview – a meaningful discussion whose primary purpose was to delve into the patient’s history (medical and otherwise), general circumstances and personal attitudes towards health and healthcare. Other professionals, such as community health workers and behavioral health specialists, may also be involved.
The interview may reveal that our patient is essentially homebound as the only informal caregiver for a senior relative, does not have reliable transportation for a colonoscopy, but would like to have the screening done after discussing some myths she had heard .
Social service professionals within her VBC team could coordinate additional care support and transportation, not only for the colonoscopy but also for routine clinical visits and deferment of care in the future. Alternatively, the patient may be offered the option of performing a stool-based examination at home.
Now extrapolate this type of care to the population level, where preventive, complex and chronic care needs are all addressed – ideally before they escalate into acute crises that require higher levels of care, such as emergency room visits or hospital admissions. This approach results in better patient care; helps providers consistently deliver high-quality, evidence-based care; and leads to long-term cost savings.
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