Upward Health’s Q&A Series: Value-Based Care
Value-based care, which ties the amount health care providers earn to the results of the care they deliver to patients, focuses on quality, provider performance, and the patient experience. At Upward Health, our goal of elevating quality, outcomes, and the patient experience aligns seamlessly with value-based care. We sat down with two members of our Executive Team, Ben Hamawy and Seth Zuckerman, and asked them a few questions on value-based care. Here’s what they had to say about one of the most discussed topics in healthcare today.
Ben Hamawy, Upward Health’s Chief Financial Officer, is responsible for leading and overseeing all financial operations including financial planning and analysis, accounting, treasury functions, risk adjustment, and revenue cycle management. Ben has a wealth of knowledge and experience as a financial leader from a national health plan working on the “other side” of value-based contracts.
Seth Zuckerman, Upward Health’s Chief Business Officer, is responsible for a range of business services that support our clinical operations. He works with health plans along the full lifecycle of a partnership, from the business development stage, through implementation, and then to ongoing success and growth of the relationship. Seth has been working on value-based contracting since the inception of Upward Health.
Q
What do you see as the biggest challenges when transitioning from fee-for-service to value-based care?
BEN: Some of the biggest challenges include financial restructuring of the payer-provider arrangement to align incentives with patient outcomes and to develop agreed-upon measurement methodology. There is a need for robust data analytic capabilities to prioritize patient engagement and to improve and measure performance and quality.
SETH: Risk-based contracts shift payment from the volume of services delivered to the value created by the services. Both payers and providers must become comfortable with the uncertainty of the outcomes, and a shared commitment to fairly measure and apportion responsibility for the results.
Q
How does quality performance tie into a value-based contract?
SETH: It’s important that a value-based contract improves the clinical outcomes for the population served in addition to optimizing financial measures. Success requires prioritizing patient-centered care, fostering strong care coordination among providers, and leveraging data analytics.
BEN: To take what Seth said and make it more concrete, we set up contracts in a way so that we earn greater savings if we perform well on measures like Controlling High Blood Pressure or completing cancer screenings. Many health plans are often more interested in achieving strong clinical quality performance than they are reducing medical expenses.
Q
Value-based care has been less common in Medicaid than in Medicare. What do you see as some of the opportunities in Medicaid?
SETH: While Medicaid is seen as more difficult due to a lower premium relative to Medicare, traditionally more challenging-to-engage patients, and the need for state-to-state approach, these factors are why considerable greenfield opportunity for value-based care exists in Medicaid!
BEN: While I saw the success of Medicare value-based care in my experience prior to Upward Health, I was unsure of the prospect of similar arrangements in Medicaid. But what I’ve subsequently seen is that state departments of health increasingly demanding that their Medicaid managed care organizations enter into risk-based contracts with their providers. Performance in certain Medicaid patient segments has been challenged by access to care issues, and a patient-centered provider group can shift that paradigm.
Q
Health plans express a lot of interest in value-based care, but developing a value-based contract can take a long time given the complexity involved. What has your experience been?
BEN: Developing value-based contracts can indeed be time-consuming due to the intricacies involved in aligning incentives and defining performance metrics. Effective collaboration between health plans and providers, clear communication, and a shared commitment to improving patient outcomes are essential for streamlining the process and accelerating the transition to value-based care arrangements.
SETH: Building on what Ben said, the historic mistrust between payers and providers are often difficult to overcome in order to reach an agreement that incentives all stakeholders to improve outcomes. Further, some payers do not have much experience with risk-based contracting. Despite the challenges, the potential benefits of value-based care, such as improved quality of care and cost savings, make the investment in time and effort worthwhile.
Upward Health has value-based contracts with multiple health plans, enabling the delivery of our high-quality care to patients nationwide.
About Upward Health
Upward Health is an in-home multidisciplinary medical group that partners with health plans and other risk-bearing entities to address the needs of high- and emerging-risk patients. Using a unique, in-home, whole-person care approach to meeting a patient’s needs, Upward Health delivers and coordinates care that improves outcomes and the quality of life for every patient it serves. It has a Net Promoter Score of 86, among the highest in the healthcare industry, and ranks No. 7 on the 2023 Inc. 5000 list of the fastest-growing private companies in the nation.
Press Contact: Ashley Kurpiewski, akurpiewski@upwardhealth.com