Page 7 - Focus March 2018

impact that we have on the people who live throughout the state of Delaware.
Lee: Your point that Christiana is the biggest provider in a small state is an important one because health policy tends to happen at a state level. That’s where Medicaid policy is made (for example), so the impact is tremendous. My understanding is that managed care in general and value-based payment in particular have not come to Delaware as quickly as, say, Massachusetts. What is the current situation regarding insurance coverage, payment reform and the Affordable Care Act in Delaware?
NEVIN: That’s an important question. Delaware is a Medicaid expansion state, and my perspective is that the state did a terrific job of rolling out all the elements
of the Affordable Care Act, including the exchanges, and we had a considerable number of Delawareans who got access as a result of both of those initiatives. The state has also been very successful in getting funding from the Center for Medicare and Medicaid Innovation (CMMI) and we are a State Innovation Model (SIM) test state. We were successful in being awarded funding to create a plan, and now we are in the final year of implementing that plan.
We started from a place of a great deal
of opportunity, particularly in terms of payment reform. The state historically has been very much a fee-for-service payment state. It’s very hard to find any evidence of capitation, total-cost-of-care arrangements. I will say, as a result of the SIM funding and the emphasis that’s been placed on creating value, and committing to reform, we’ve seen some changes start to take place.
We are the owners that helped create a statewide accountable care organization, as an example. We’re in our third year of a Medicare Shared Savings Program ACO. We’ve had the privilege of caring for about 50,000 Delawareans, and not just those
in New Castle County or those who come
to Christiana Care, but because we’ve partnered with the other hospitals and healthsystemsinthestatewearetrulyable to deliver that approach to care statewide.
“For us, that’s the important piece of all of this, our opportunity to create value, and create value in the way that we’ve defined it, which is, how do we help people achieve the outcomes that are important to them, and how do we do it in a way that respects cost and creates portability?”
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We also were fortunate to partner with Aetna beginning last July of 2017, and we’re caring for close to 30,000 state employees and their dependents. That is in a version of a total-cost-of-care model, meaning
that if we are successful in helping the state achieve the spending target for that population, if we exceed their goals, there’ll be an opportunity for sharing.
But what’s new for us, and what’s new in the state, is that if we are not successful and
we do not help them achieve their spending goals, then Christiana Care, in partnership with Nemours, our children’s health
system here — we’re on the hook for that difference. If we don’t deliver, the governor will be getting a check signed by me for the difference in that cost.
We’ve also seen, more globally, a shift
to some of the initial stages of value- based payment. Pay-for-performance has taken root, and increasingly many of the contracts that we’re looking at both inside our organization and with what we know is happening with the private practice community — more and more of the revenue that we earn is grounded in value.
For us, that’s the important piece of all of this, our opportunity to create value — and create value in the way that we’ve defined
it, which is: how do we help people achieve the outcomes that are important to them, and how do we do it in a way that respects cost and creates portability? By committing not only to driving the best performance
in terms of how we deliver care, but also to thinking about how that care gets paid for, when that comes together we have the greatest impact for change.
When I talk to folks about where we are as a system, and our opportunity in the state, Italkaboutthepastasbeingasuccessful
hospital system, and we were that. We are currently, I believe, a successful health system in that we’ve started to build those components, the infrastructure that will support value-based care, risk-based payment. So where we are going, and where we must be, is a system that truly impacts the health of the people of Delaware. And
it means taking responsibility not only for those who seek out care with us, but for all the people who live in the communities throughout Delaware.
LEE: As someone who’s been watching and, frankly, admiring what you’re doing, my take is that you’re not just reacting thoughtfully to market challenges. You’re actually trying to show leadership. You’re trying to pull the system in the right direction as opposed to fending off change that would disrupt things for as long as possible. Is that take right? And then the follow-up question is, why? Why are you doing it? So many other folks I know are trying to delay disruption to the status quo because it does make life that much harder.
NEVIN: It’s in our DNA that we’re never satisfied with the status quo. I firmly believe that we need to lead and to take re- sponsibility to disrupt ourselves, and so we have been committed to that and remain committed to that. I have said, not only in- side the organization but at the board level and publicly, that I am desperately seeking capitation. If we sit back and wait for things to change, we lose a great opportunity to shape our own future. More importantly, doing this work gives us the opportunity
to do what needs to be done to transform the delivery system and make a difference in how we care for people, and then how peopleexperiencehealth. CONTINUED
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