Natural Owners of Risk for High-Risk Populations: Who Should Take Accountability for the Chronically Ill?
As health care evolves farther towards value-based care, payers and providers will need to tighten their strategies on how to effectively manage their high-risk populations. Patients with multiple chronic conditions account for 12% of the American population who drive 41% of health care spend. It is therefore essential that population health programs uniquely account for the most chronically ill patients in order to effectively move the needle on cost of care.
As they transition to value-based care, payers are well into the process of establishing risk-based arrangements with their provider partners. Often, these arrangements are structured around the natural owners of risk for a given population. For cancer patients, this often means oncologists and their provider groups. For orthopedics, bundled payments have been effective in spots. For End Stage Kidney Disease (ESKD) and Chronic Kidney Disease (CKD) patients, this often means nephrologists and large kidney care providers. Our parent company, DaVita, is a great example of this as it has transitioned a large number of its fee-for-service payer contracts to risk-based arrangements. DaVita believes that kidney care providers, along with partner nephrologists, should be accountable for the total quality and cost of care for every ESKD and CKD patient.
At Vively Health, we believe that a health plan’s Most Vulnerable Patient (MVP) population, members with multiple chronic conditions who are often the highest utilizers of health care, should be at the top of the list for their own tailored care models, value-based contracts and unique risk pools. The problem is that it’s hard to find a natural owner for these patients as they typically have anywhere from 3 to 10 interrelated chronic conditions. Furthermore, these chronic conditions aren’t always static so patients who are steady one year could be high risk the following. In addition, PCPs often struggle to provide the care these patients need as they require more time than a typical 15-minute office visit allows, routine follow-up, and immediate care when flare ups occur.
That’s where Vively comes in. We provide primary and supplemental care within the home for the highest-risk, highest-cost, and most chronically ill patients. And we do this at full risk through our health plan partnerships. Our medical group is physician-led and community-based, which means no doctor offices or physical clinics. It’s all about house calls. Each member receives personalized care from a team of providers in the convenience of their own home. With 90% patient satisfaction, 40% fewer hospitalizations, and 20% lower cost of care, our results have proven that this highly personalized care model is essential to move the needle for this population.
As payers continue to outsource risk to provider groups, they should consider carving out high-risk populations from their general risk pools. These members are best served by their natural owners of risk who can provide personalized care models that are aligned with their chronic conditions and care needs.