This week, Eric is joined by Rick Goddard, Senior Director of Market Strategy for Lumeris, an operating partnership company that helps health systems generate enterprise value through population health services, analytics and technologies.
Eric and Rick discuss the evolution of value-based care over the last decade; the ins and outs of Direct Contracting Entities (DCEs), which Rick describes as one of the “most progressive” options in value-based care; and how a partner like Lumeris can help health care systems transition to value-based models.
Rick also makes some predictions about pop health trends for 2022 and covers value-based care entity governance.
Here are more highlights from Eric’s discussion with Rick:
On the role of direct care entities (DCE) as the Medicare Trust Fund nears depletion:
"CMS listens and they tried to put together a program that balances beneficiary interests at the top with trying to manage the Medicare Trust Fund’s depletion, which could come as soon as 2026. We’re ending 2021 and still having fights over where to put money for earning savings for Medicare. This is a dangerous time for all taxpayers, as we see this change and we’re still fighting with political issues to essentially manage a bipartisan program in Medicare and Medicare Advantage to help beneficiaries and help the Medicare Trust Fund be sustainable. So I consider direct care [DC] as being the most progressive. It’s not perfect, but it has built and taken on all of the progression that we’ve taken the last 10 years of value-based care and built it into a Medicare program that can not only influence Medicare, but how networks operate in a given market and how it will affect commercial insurance going forward."
On the paradigm shift for health care financials and operations coming out of COVID-19:
“Our partners that we’ve worked with in this space have been incredibly progressive. They’ve been major public health supporters to their communities, which COVID requires them to, while being able to be financially sustainable. I’m incredibly proud of our partners being a part of that. Those are our healthcare heroes. But I would just caution folks: Take a look at what’s happened around you the last two years. The physicians are changing their position. The market and consumer has changed their view of health care. The growing cost of employer-based insurance is making employers very sensitive and focused on how to get employees to be appropriately getting the care that they deserve at the price point that they want. Transparency on pricing is changing. It’s going to be a different environment. The strategy needs to change.”