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Team-Based Model Key to Achieving the Quadruple Aim at Reliant

Achieving the goals of value-based care will prove elusive unless the healthcare industry also addresses provider burnout and the quadruple aim.

Source: Thinkstock

By Kyle Murphy, PhD

- The key to success in value-based care is sharing the workload, claims the head of Reliant Medical Group.

 “One of the things we know need to solve for and we have by no means have is getting away from one person needs to shoulder the burden entirely alone,” Reliant President & CEO Tarek Elsawy, MD, FACP, told EHRIntelligence.com.

Improving population health, increasing patient satisfaction, and reducing cost — the triple aim — will fail to take hold without increased support for the providers who shoulder the lion’s share of responsibility for the transition to value-based care.

“Historically, we have been taught to manage everything from beginning to end ourselves,” he continued. “To this day most electronic health records are quite frankly still very sophisticated filing cabinets and have not really delivered on the promise of making the lives of providers better. Instead of concentrating holistically on the patient, they are almost in a competition to pay enough attention to the patient and the system pinging them with best practice alerts and all kinds of other things all the time.”

A team-based approach is at the heart of value-based care implementation across Reliant.

“Our team-based model of care delivery is also going to have a significant impact on provider burnout and our early results show that we haven’t had anyone who has experienced the model said they prefer the old way and request to go back. That’s been incredibly reaffirming,” Elsawy explained.

These early results gain further credence with the recognition of the healthcare organization as a top place to work by The Boston Business Journal. Reliant was the only provider group to crack the top ten. So then what has enabled the organization to succeed both as an operation and implementer of value-based care? As it turns out, the recipe for success has several key ingredients.

A commitment matched by investment

It’s one thing to voice support for value-based care. It’s another to make a significant investment in a care delivery model by reconfiguring an organization’s resources. “Unless you’re putting your resources behind excelling in value-based care, it’s just rhetoric,” said Elsawy.

Reliant’s leadership has looked to both its medical personnel and physical infrastructure as opportunities to put the idea of team-based practice into action in the name of value-based care.

“What we’re doing is unusual — we’re making our facilities match the care model. Most people inherit a building and configure themselves around the facility,” the former Cleveland Clinic executive and internist revealed. “We’re configuring the facilities on a model of team-based care of physicians, advanced practitioners, nurses, medical assistants, behavior health specialists, pharmacists, etc. all collocated. Patient-centered care? We are taking that literally where the patient is in the center of all of that.”

The physical restructuring taking place throughout the organization falls in line with its leadership’s vision for what constitutes success in value-based care.

“Value-based care is a complex concept, it but it boils down to the way that our patients or consumers can interact with our organization or any complex healthcare system in a fairly seamless way,” said the former Cleveland Clinic executive and internist.

Roughly forty percent of the entire healthcare organization has undergone the change. That speaks to Elsawy’s own commitment to the team-based approach during his two years as head of the organization. When he began in late 2015, one exemplum was in existence.

Aligning of care models, compensation, and risk

The source of Reliant’s top-line revenue uniquely positions the healthcare organization spanning central Massachusetts to tackle the reimbursement component of value-based care.

Three-quarters of this revenue comes from full global risk at Reliant. “We’re not talking theory. This is what we’re actually doing, which clarifies and aligns you pretty quickly,” Elsawy noted.

Healthcare organizations relying too heavily on relative value units and provider productivity based on these metrics miss the big picture of value-based care, namely compensation tied to patient satisfaction and access to care.

“That’s almost the antithesis of what you’re trying to do within a value-based care organization,” Elsawy argued. “People have to pay attention to the concept of compensation models and incentivizing everyone in the organization to do the right thing. That’s a difficult and tricky component.”

Compensation goes hand in hand with understanding actuarial risk as a risk-bearing organization as many an accountable care organization has come to discover when addressing value-based care year over year. These skills are necessary to success but unlikely to already be in hand.

“Without great actuarial talent and resources, it’s really hard to figure out true cost structures such as cost to the organization for providing a given service,” Elsawy said. “The concepts of actuarial science and true cost accounting are not necessarily native to most provider organizations. Also, it’s naïve to think that you can develop it quickly. You’re either going to partner with people who can do it or make some incredibly heavy investments to get there.”

The ability to outperform the market comes from combining internal data on how effectively an organization’s providers deliver a particular service with external information about the demand for that service and its opportunity to generate savings into the future.

Value-based care as an organization-wide effort

The healthcare industry finds itself at a pivotal moment, only part of the way through the transition from fee-for-service to value-based care. Some within the industry still resist the notion that the latest attempt at capitation will succeed where its predecessors have failed.

Having a methodical transition plan that engages the entire organization is a critical component of Reliant’s strategy for overcoming this opposition and building momentum for its team-based approach to care delivery.

When the organization committed to adopting value-based care, it went all in across all departments to make clear its ultimate goals.

“It’s tempting to say that value-based care is a primary care thing,” Elsawy remarked. “It’s not — it’s the whole organization. Unless you’re willing to say this is all of us, it becomes difficult to execute on that. If you think you’re going to flip a switch, that’s fairly erroneous. You have to manage both fee-for-service and value-based care, and the direction of the organization needs to be clear to everyone. Yes, we understand we are in a transition period, but we are not going back.”

The head of Reliant is firm in the belief that the organization’s team-based approach to value-based care will win out in the end, but he is quite frank about the work before him.

“Make no mistake: We still have some providers who like the way they’re practicing and aren’t all on board with team-based care,” Elsawy observed. “When you have been trained to do things one way and then all of the sudden it must evolve to include all these other team members, it’s a difficult change. But you have to let the data speak for itself and the data so far shows that every single provider that we put into the team-based care model, not one has wanted to go back.”

Creating a single standard of care

Changes in the provider workforce and consumer expectations for care together necessitate a new way of doing business in healthcare.

“If we are waiting for the day when we will be replacing one primary care doctor with another, the model has to change considering the needs and supply of primary care,” Elsawy maintained. “Patients have also started to become more and more adapted to being managed by a team of folks rather than a single provider because they understanding things are getting really complicated. And quite frankly I’d rather have a team of folks responsible for me than just one person.”

Rather than fight the inevitable change to care delivery, Reliant has embraced value-based care as its go-forward strategy. To that end, every patient — event that 25 percent not covered by full global risk — is now the recipient of a team-based approach to care. While that decision does not prove financially beneficial to Reliant’s bottom-line, it most certainly falls in line with the organization’s vision for achieving the quadruple aim.

“Ultimately, we are all going to be judged on providing great outcomes, treating people compassionately, and doing so in a way that’s affordable,” Elsawy affirmed.



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