Value Based-Care

A Conversation with Bob Riney, Henry Ford Health President and CEO

Henry Ford Health President and CEO Bob Riney recently called out value-based care/contracting as one of the top areas of focus that will distinguish the health system’s future. As part of the Henry Ford Physician Network, you are part of what will move that needle for Henry Ford and your practice.

Currently, all of our HFPN providers – whether fully independent, part of a Physician Organization, or a member of the Henry Ford Medical Group – participate in a number of contracts with value-based terms. These contracts have always resulted in meaningful rewards for providers.

Bob recently sat down with the HFPN to discuss the history of value-based care at Henry Ford Health and why it is such an important part of its future. Below is an excerpt from that conversation:

Q. Can you please recount when Henry Ford entered the value-based world?

A. “That would be when we acquired Health Alliance Plan (in 1986). At that same time, what was called ‘managed care’ or HMOs, were really evolving. At that time there was anticipation that they were going to become the predominant model of the payor/provider relationship in the state, with the anticipation that it would reach market penetration as high as 60%. So, for Henry Ford, it was both a philosophical and strategic decision to lean into what is now called value-based care, or population health.”

Q. What happened to that momentum?

A: “It’s important to remember that change is often not a straight line. When HMOs were introduced, they were expected to become dominant, but it didn’t happen. The Michigan growth did not accelerate the way the West Coast’s did under Kaiser Permanente’s model, primarily due to political, business and cultural issues in our state. The resistance was related to a perception of a lack of freedom of choice and of provider.”

Q. What was the takeaway from that foray into value-based care?

A. “We realized that a lot of education has to take place ahead of culture change. And going from a fee-for-service model to value-based is certainly a culture change. It’s culture change for providers and consumers … in a big way. It can be seen as a takeaway instead of what we, in healthcare, see as a strength. We see it as a strength because of its focus on coordination of care that can result in higher quality of care, evidence-based diagnostics and treatment, and enhanced communication between providers.”

Q. Where is Henry Ford Health now on the track of value-based care and contracting?

A. “I like to say we are now at a 2.0 stage, if you will, where value-based care and population health is really being incentivized by putting the right risk/reward portfolio together. I also believe that consumers are now far more educated on the value of having coordinated care, and to have their primary care physician play a more prominent role in their care than in the past.”

Q. How do you think these patients/consumers are learning about value-based care?

A. “I think in a few ways. One is, they’re learning from a firsthand financial standpoint that these kinds of plans can be very cost effective to them as it relates to their copays and their premiums. Secondly, they’re learning, just as is the whole country is learning, about trying to move toward health and preventive measures. A model like this is much more conducive to being more proactive with their health. Third, they’re learning about something we didn’t have back then: a fully integrated electronic medical record and how they can use that to participate in their own care.

“I also think that consumers are seeing the benefits of using the electronic record to take care of registering, pharmaceutical reconciliation, pre-visit questionnaires and such, and how it then increases the value of their interaction with their provider. If ‘busy work’ like that is not done beforehand, the PCP has to go through and validate all of the information. That takes precious time out from the interaction where the provider could be focusing on things such as your goals in life, problems you want to work together on solving. It is those types of experiences where you walk out feeling greatly engaged with your provider and the care you are receiving.”

Q. Most people would agree that this sounds like a great plan. But how can Henry Ford reconcile the financial hit when value-based care is done correctly? In a perfect world, that means fewer patients in the ED and in inpatient beds.

A. “There is a funny saying in the industry: Demand Destruction. The belief is that you’re, in essence, destroying the demand from the traditional model and its financial rewards. I don’t buy into that. Because I believe that these two aspects of care have a great relationship when done right. What I mean by that is, our goal is to lead the state in the value of population health and value-based care. Yes, that existing population may need less of the acute services. But at the same time, we should be attractive to a wider market. In that case, the funnel should build and grow.

“You are always going to have a percentage of patients who need tertiary and quaternary complex care. No matter how health-focused one leads their life, inevitably, there are needs. I think that if you widen the net, you will have all the demand you need for your T/Q and more complex services. I see these as mutually inclusive. It’s not an either/or, it’s a both/and.”

Q. With potentially fewer patients in the high-cost areas of care such as the ED and inpatient rooms, will this impact quality of care in a positive way?

A. “When done correctly, what it means is what we are now seeing individuals who end up in the hospital – other than for births and such – are acutely ill. They’re going to need more services and more specialty-based clinicians because the complexity of the care requirements. This trend will allow the shift to take place in a logical and rational way.”

Q. Does this also meld with Centers for Excellence?

A. “It melds well with the whole continuum. It melds well with value-based care because quite frankly, the earliest diagnosis in cancer, cardiovascular as two examples, means less acute and less invasive procedures will be needed. If we are dedicated to the health of the community, we have to feel good about that. So yeah, it may create a shift in the mix of what people are accessing within the organization, but the services lines themselves will grow.

“The other thing we need to talk about when people think of Demand Destruction is that we are a state that is aging-in-place. We have and will have a very, very robust volume of seniors. Those seniors are going to need T/Q services. Our goal is to help people to lead healthy lives. But inevitably the demand will be there for T/Q services simply because we have that large aging-in-place population.”

Q. You mentioned education in the community regarding value-based care. How will that happen? How do we reach beyond current patients with this education?

A. “The traditional methods of using marketing, print media, social media – they all play a role. But if we’re honest with ourselves, this is still an incredibly word of mouth business. Even the most sophisticated consumer pays more attention to what their reliable friend says than what a ranking in a publication does. That means our patients and our team members are our chief marketing officers.”

Q. How is Henry Ford Health advancing the work and scope of our HFPN independent providers and those within our Physician Organizations?

A. “The key is through our service lines and primary health because, by design, they are meant to be pluralistic. We want a robust group of aligned physicians around value, regardless of what employment business model they are part of. Additionally, we have to make sure our geographic spread and our network of referrals are encompassing of the entire community of physicians that align with us – and these referrals go both ways. We are not perfect, but we’ve come a long way regarding bringing value to all stakeholders. We need to continue to educate ourselves that within the HFPN there are amazing physicians aligned with Henry Ford. They may have different business models, but all meet our level of excellence in clinical care.”

Q. So do you see a closer alignment with non-HFMG physicians going forward and building on the excitement around Destination Grand?

A. “Absolutely. And we’re in a position to do that, especially as we look to expand our geographic footprint. We can definitely go further, as will our brand. That Henry Ford brand will continue to soar and our physicians within the HFPN will benefit directly from that. We want to make sure that Destination Grand lifts all of Henry Ford Health, and that includes our independent physicians. This is our moment.”