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Finance editor reports on how health systems replace fee-for-service with value-based payment Date: 07/01/16

By Christopher Cheney

When revolutionary change sweeps across an industry, innovation is among the most thrilling journalism beats.

In the health care-industry revolution prompted by the Patient Protection and Affordable Care Act in 2010 and husbanded by the Obama administration, the pioneers face a harrowing ride, with providers and payers playing the role of test pilots for a slew of new business models in the shift away from fee-for-service medicine to value-based care.

Tagging along with the pioneers to chronicle their story can be a bumpy ride, too. Health care innovators are on the cutting edge of change, often with no road map and never with historical trend data in hand. One of the oldest implements in the journalism toolbox becomes essential: finding reliable sources and trend setters who can help guide the reporting of the story through the twists and turns of an evolving marketplace.

Although the pace is accelerating this year, adoption of value-based payment models in health care remains on a course as bumpy as a pot-hole-infested New England road after a harsh winter. Even the large health systems that have been leading the movement away from fee-for-service medicine only have a couple of years of experience in new payment models such as the Medicare Shared Savings Program and episode-of-care contracting with commercial payers. At least 85 percent of rural health care providers have not even begun their journey away from fee-for-service medicine, an official at the National Rural Accountable Care Consortium told me for a recent HealthLeaders Media Finance Column.

Trust is the key ingredient in the relationship between reporters and sources. When I hopped on the Bumpy Value-Based-Care Bus for the September 2015 cover story of HealthLeaders magazine, "Developing Value-Based Models," I tried to find the most trustworthy guides possible.

'Content guru' plays crucial role

For every HealthLeaders cover story I have produced so far, one consultant with deep knowledge of the subject matter has served as content guru. For the "Developing Value-Based Models" cover story, Harold D. Miller, president and chief executive officer of the Pittsburgh-based Center for Healthcare Quality and Payment Reform, played a key role pulling the nuances from my research and interviews.

In September 2014, I saw Miller participate in a panel at The Economist's Health Care Forum in Boston, which focused on innovation in the health care industry at the global scale. His command of topics related to alternative payment models and making significant strides toward value-based care stood out, even in a field of speakers flush with world-class expertise. Miller contributed to a story I wrote after the conference, and he has since provided me with valued insights for several other projects, including coverage of efforts to repeal and replace Medicare's reviled SGR formula for physician compensation.

My consultant content gurus for cover story projects endure two hour-long interviews, one early in the research stage and the other at the end of the research effort. For this cover story, Miller helped me reach a crucial conclusion: I had determined large health systems were leading the first charge to implement value-based payment models, and Miller told me that large health systems have a depth of resources that others lack. His insight explained why the big players were making the biggest strides.

Finding trusted partners at primary players

A pair of health systems played a pivotal role in this cover story, each with trusted sources, but trusted in different ways.

I knew Intermountain Healthcare had been operating with core elements of value-based care such as cost containment and risk-based contracting for three decades. I also knew that Greg Poulsen, senior vice president and chief strategy officer at Intermountain, had contributed to HealthLeaders projects in the past. One of my best press relations contacts has an account with Intermountain, and I arranged an hour-long interview with Poulsen, who was not only articulate but also invaluable in providing a detailed view of a large organization that had achieved a measure of success operating value-based care models.

My second prime health system source was Catholic Health Initiatives, which provided extensive and detailed content for this cover story. CHI was on my value-based-care radar from earlier coverage I had produced about the health system's internal payer business unit, Prominence Health. CHI's press relations guy, Mike Romano, is a top-notch communications professional. When I sent him an email about this cover story, he pounced. Romano wanted CHI on the cover of the magazine. Although I could not and did not make any promises, I told him what it would take to maximize his cover-art odds, and he delivered. Three top CHI executives, including president and chief executive officer Kevin Lofton, participated in the project, with hour-long interviews and follow-up Q&A via email conducted with each source.

Good character best trust metric

The first time I met James "Larry" Holly, M.D., the SETMA chief executive officer was the featured speaker at the 2015 HealthLeaders Media Revenue Cycle Exchange in Austin. The physician practice leader spoke after the meeting's formal dinner.

I try to get to events early and was the only HealthLeaders staffer in the ballroom when Holly arrived before the other dinner guests. We talked for at least 10 minutes and enjoyed sharing our mutual interests in history.

Holly told me about serving in an African medical mission for his church as a young man, while the civil rights movement played out at home. When he returned to Louisiana and was invited to speak at his church, Holly did not talk about providing medical care in Africa; he spoke about racial injustice in America. When he stepped down from the pulpit and walked into the center aisle, the congregation shuffled away, parting in the pews like the waters of the Red Sea under Moses' staff.

I would trust Holly with my life, so trusting him to provide the physician-practice perspective on adoption of value-based care models was easy.

Christopher Cheney (@cccheney) is a senior finance editor for HealthLeaders Media.