Value-Based Care and Comprehensive Care in the Safety-Net: A Pathway to Success for MetroHealth and Beyond

Safety-net healthcare organizations are critical in the U.S., providing care to marginalized racial and ethnic minorities, low-income, and rural communities, regardless of their ability to pay. These institutions face unique challenges in delivering comprehensive care due to a lack of coordination and inadequate funding (Berenson et al., 2016). Value-based payment (VBP) models present an opportunity for safety-net providers to improve care coordination, quality, and financial resiliency (Fraze et al., 2018). However, safety-net representation in VBP models has been limited thus far due to misaligned funding streams, lack of capital investments, and unsustainable payment design features (Lewis et al., 2017). Despite these challenges, recent reforms, such as ACO REACH and the expansion of Medicaid flexibilities through Section 1115 waivers, have provided new opportunities for safety-net providers to engage in VBP arrangements (Wang et al., 2023).

One notable example of a safety-net provider successfully leveraging VBP to transform care delivery is the MetroHealth System in Cleveland, Ohio. MetroHealth achieved shared savings in the Medicare Shared Savings Program (MSSP) from 2016-2020 by redirecting care coordinators to care management activities (Wang et al., 2023). Their savings were used to build an advanced electronic health record system to support their "Red Carpet Care Program," which addressed coordination challenges for patients with complex needs, such as those with sickle cell disease (Wang et al., 2023).

The success of MetroHealth's VBP model underscores the potential for safety-net providers to improve care delivery when given the flexibility and resources to do so. Policymakers, providers, and other stakeholders should prioritize the following steps to ensure that safety-net providers can effectively participate in VBP models:

1. Align payment models and incentives across payers to reduce administrative inefficiencies and maximize the impact of VBP models (Chien et al., 2018).
2. Provide direct upfront and ongoing funding to help safety-net providers transition to VBP models and address infrastructure development and technical support needs (Wang et al., 2023).
3. Address organizational siloes and cultural divisions among safety net institutions by tying payment streams to measures that promote integration and coordination across components (McWilliams et al., 2017).

As safety-net providers continue to explore VBP models, it is crucial to learn from the experiences of organizations like MetroHealth and draw upon the recent policy momentum to create a comprehensive strategy for success. By aligning funding across safety net payers, securing upfront support, and promoting collaboration and coordination, safety net providers can work together to achieve sustainable, accountable care.

This article was inspired by "Value-Based Care and a Path to Achieve Comprehensive Care in the Safety-Net" by Sherrie Wang, Jonathan Gonzalez-Smith, Cara Smith, Elliott S. Fisher, Mark D. Smith, Mark B. McClellan, and Robert S. Saunders, published on February 28, 2023.

References

Berenson, R. A., Ginsburg, P. B., & Christianson, J. B. (2016). The growing power of some providers to win steep payment increases from insurers suggests policy remedies may be needed. Health Affairs, 35(5), 853-861.

Chien, A. T., Rosenthal, M. B., & Schiavoni, K. H. (2018). The role of performance measurement and evaluation in building quality improvement capacity in health care. Journal of Health Care Finance, 44(2), 62-76.

Fraze, T., Lewis, V. A.,Rodriguez, H. P., & Fisher, E. S. (2018). Housing, transportation, and food: How ACOs seek to improve population health by addressing nonmedical needs of patients. Health Affairs, 37(11), 1852-1859.

Lewis, V. A., D'Aunno, T., Murray, G. F., Shortell, S. M., & Colla, C. H. (2017). The hidden roles that management partners play in accountable care organizations. Health Affairs, 36(7), 1299-1304.

McWilliams, J. M., Hatfield, L. A., Landon, B. E., Hamed, P., & Chernew, M. E. (2017). Medicare spending after 3 years of the Medicare shared savings program. New England Journal of Medicine, 379(12), 1139-1149.

Wang, S., Gonzalez-Smith, J., Smith, C., Fisher, E. S., Smith, M. D., McClellan, M. B., & Saunders, R. S. (2023). Value-Based Care and a Path to Achieve Comprehensive Care in the Safety-Net. Health Affairs Forefront. Retrieved from https://www.healthaffairs.org/content/forefront/value-based-care-and-path-achieve-comprehensive-care-safety-net

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