Enjoy this recap of our February 11 winter conference at The Phoenix Art Museum Singer Hall courtesy of Sally Engelman, Director, Strategic Partnerships for Lumeris. Don’t miss the bonus slideshow of the event.
The Arizona healthcare community came together for the Hertel Report State of the State to reflect on the pandemic, acknowledge and celebrate the advances and achievements in 2021, and to set forth ambitious plans for 2022. The meeting featured insightful and inspirational speakers that detailed concrete steps necessary to move towards true value-based care for all Arizonans. I look forward to observing these changes in real time, and to continue to engage with the incredible leaders in the Arizona market. Until next year!
The Hertel Report State of the State
Highlights of the Sophisticated Arizona Market
At 7 a.m. on a clear sunny morning, I walked through the Steven Spielberg entrance to the Phoenix Art Museum into a warm room filled with the who’s who of Arizona healthcare and the smell of bacon. As first time SOTS attendee, I wasn’t sure what to expect. Though I’ve spent the last 8 months researching the Arizona market, I was pleasantly surprised to learn about the innovative and pragmatic approach to value-based care delivery. Government agencies, health systems, physician groups, patient advocates, Indian health officials, and private companies are finally able to come together for the first time since early 2020, during a lingering and a devastating COVID pandemic, to continue to collectively work towards the common goal to ensure Arizonans receive the highest quality, lowest cost, and most accessible healthcare possible. I was taken aback by the depth of the relationships that I witnessed in that room, and the staunch commitment each organization and individual has made to Arizona healthcare.
The event started with a somber moment of silence and remembrance for those that passed away during the pandemic. Many in the room witnessed firsthand the devastating impact of the pandemic, and many were on the front lines valiantly fighting to mitigate the damage. After remembering those lost, Jim Hammond, CEO of the Hertel Report, pivoted to celebrating healthcare workers, a cathartic moment fitting for this uncertain time. Acknowledging the ongoing hardships facing Arizona only served to reinforce the collegial atmosphere in the room. Jim explained that through his work with the Indian Health Service, he had learned that it’s customary to start a meeting with a story to frame the conversation.
Jim then introduced Gail Zahtz, CEO of Wisecare and cancer survivor. Gail shared her story of overcoming metastasized cancer while being a single mother of four young children. Gail’s presence captivated the room, and her story of courage and tenacity served as a reminder to those in the room why we work in healthcare. Then—it was time to get down to business. Four guest speakers took to the podium to discuss the latest and greatest healthcare achievements and aspirations.
Five themes traversed every presentation and are indicative of the overall shift in Arizona from fee-for-service siloed care to an interconnected value-based care delivery healthcare system.
- “Social Determinants of Health, have you heard of them?” was playfully repeated by almost every presenter. Addressing social determinants of health is a central tenant to the value-based care approach in Arizona. More than just a buzzword, SDOH affect every aspect of care delivery. A concentrated and prescriptive approach is necessary to address economic hardship and social issues that in turn are affecting health and adherence to treatment plans. Speakers described data-driven approaches to addressing SDOH from various angles in their respective talks, focusing on non-traditional insurance benefits, reducing physical and technological barriers to access, and improved interoperability through HIE participation, detailed below.
- Non-traditional health benefits are gaining popularity in Medicare and Medicare plans. Jami Snyder, Director of AHCCCS, described supplementary benefits that were being piloted in some populations, such as pre-paid grocery cards and in-home improvements such as ramps and handrails, to help bridge gaps that socioeconomic circumstances can create. Similarly, Dan Vincent, founder of Med-Care Senior Insurance Solutions, recounted that the seniors who are purchasing Medicare Advantage plans are increasingly seeking $0 co-pay options as well as benefits that cover dental, vision, and home improvements. Both Snyder and Vincent emphasized that educating Arizonans on the availability of these benefits and ensuring that they are utilized are still a challenge, and a more concerted effort by both care providers and health plans to identify beneficiaries who may benefit from supplemental benefits are underway, including the Closed Loop Referral Program which has been implemented to refer beneficiaries to community-based organizations focused on addressing SDOH.
- Some Arizonans are challenged with physical and technological barriers to accessing healthcare, specifically those who live in less densely populated areas or of a lower SES. The telehealth boom early in the pandemic has waned, and the populations who may have benefitted from telehealth in rural areas still have obstacles to access, such as lack of internet connectivity or device to facilitate telehealth services. In response, some payers have provided financial assistance to beneficiaries for broadband access, and in some cases, devices like tablets to facilitate telehealth. In addition, investments are being made in critical access acute care facilities to provide more complex healthcare services such as dialysis and increasing access to transportation to enable more patients to receive in-person care. Vincent mentioned that even if Medicare beneficiaries are given tablets and internet access, it’s also vital to ensure seniors can use the tech they are given. It will be crucial to analyze the uptake of these solutions, specifically to ensure that beneficiaries are able to take full advantage of these services by providing education on use, to verify that access to care is actually improved.
- Zooming out from SDOH, interoperability through HIE participation continues to be a necessary step for health systems and payers to take to create a more seamless transition of care for patients between different care providers in various acuity settings. Melissa Kotrys, CEO of Health Contexture, applauded the 910 organizations in Arizona that have already started participating in the HIE, however, she also described that some organizations continue to be hesitant to join. Though interoperability seems like an insurmountable goal, Health Contexture, a state-wide non-profit that facilitates HIE, has made significant advancement in healthcare interoperability by incorporating 275 data sources sharing unidentifiable patient data, encompassing 98% of Arizona hospitals. Currently, more than 14 million patient records are available, and the number is growing every day. It is essential for Arizona healthcare providers and payers to participate in HIE and data sharing to break down silos of care and in turn lead to improved patient care.
- Finally, funding of population health initiatives, such as the ones described at the SOTS and beyond, remains a challenge for providers. CMS and CMMI have signaled in their most recent update that to continue the shift from FFS to value-based care, providers must take on more risk and responsibility for funding care. The previous administration’s CMS/CMMI introduced the Global and Professional Direct Contracting model (GPDC) which has been re-vamped under the current administration to Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) Model. Both models allow primary care providers to receive capitated or sub-capitated payments for Medicare FFS beneficiaries, to “improve the quality of care for people with Medicare through better care coordination, reaching and connecting health care providers and beneficiaries, including those beneficiaries who are underserved.” (CMS Innovation Announcement, 2/24/22). The program also allows for enhanced benefit design, closer to the MA plans with some the non-traditional benefits Snyder and Vincent described. CMS also pledged to be more transparent on participants in the model, releasing a list of participants with their announcement. Of note, Arizona has 25 registered DCEs, the fourth most DCE saturated state after Florida, California, and Texas which have significantly larger populations, creating an incredibly competitive Medicare FFS landscape. Jim and the speakers dedicated time to discussing the new CMMI model, most attendees agreed that more time was necessary to dig into the details to understand how to best leverage the model to achieve the goals set forth by Arizona’s healthcare community. Jim, time to plan another summit for this dynamic group!
2022 Winter State of the State
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1 Comment
Jean Rice
March 17, 2022 at 5:30 pmI loved watching the video of the SoS since I was unable to attend. I did see a lot of smiles and handshakes so friends and new acquaintances alike were welcomed.
Great job as always by the staff at The Hertel Report; thank you Jim for putting this event on year after year!