Today we’re talking to CHESS Health Solutions own Tammy Yount who shares her experience as a former practice manager and AHEC practice support coordinator to provide insight on why independent primary care providers, their practices, and especially their patients, will benefit from partnering with the right clinically integrated network.

Tammy Yount, welcome to the Move to Value podcast.

Glad to be here, Thomas.

Tammy, what are some of the primary reasons independent providers choose not to participate in Medicaid or why they might hesitate to increase their Medicaid patient population? Are there particular challenges they face in serving this group?

I think one of the biggest barriers is that we still are in this productivity mindset where that time is money paradigm and the goal was to maximize the amount of patients you could see within an 8 to 10 hour day in 15 minute slots. And so, when you think about the reimbursement rates of Medicaid, they tend to be the lowest reimbursement rates coupled with the administrative burden and the regulatory requirements with that. And then oftentimes you have unreliable payment schedules and meaning there may be delays and payments, or whenever there's budgeting shortfalls, or if there's a delay in payment because the state doesn't settle on a budget. Then you also have patients who are high resource demand, and then you have limited resources. So, when you're dealing with patients who have complex health needs or they have social needs or you're dealing with patients who you might need a broader provider network in terms of specialist and those specialists don't accept Medicaid. So you really are looking at a lot of complex issues that when you're thinking about in terms of the overarching population, it is just sometimes maybe the, for lack of a better analogy, the juice isn't worth the squeeze and we don't want we don't want to think of it like that because our patients, it should be patients first, but oftentimes it's a lot of resource intensive and time intensive work.

North Carolina's managed Medicaid program is a significant shift for many providers. Can you tell us why this new model represents an opportunity for independent providers, particularly when it comes to improving care quality and practice sustainability?

So really, as we move away from this productivity model of healthcare into this paying for value, the Medicaid managed care model has incentivized providers to provide quality care. And they reward them for meeting performance metrics and improving patient outcomes. And the model also allows for per member per month care management fees. So advanced medical homes who meet certain requirements are able to receive these care management fees. And they're able to address the medical, behavioral and social needs that align with the holistic care delivery model. And then also they have included some enhanced reimbursement models and shared savings models where they're allowing for value based payments and risk based contracts that can provide for more, like, predictable revenue streams and then the backbone of all of this is the infrastructure and access to resources that we didn't have prior to Medicaid managed care launched and the plans now offer support for population health management in the form of like data sharing. We have claims data, we have risk data, we have pharmacy lock in data, all of these data sharing has allowed us to be able to risk stratify the patients, align our efforts to those patients who need more intensive care management. We've also have some innovative models like the healthy opportunity pilots that allow the plans to pay for social determinant interventions, things that we weren't able to pay for before. So really it is moving to a more holistic and accountable and value-based care models.

That’s interesting. Well, from your perspective, what are independent primary care providers looking for in a clinically integrated network and what qualities or resources do they value the most?

So, I will say in my work as a practice manager and then in my subsequent years as a practice support coordinator for the North Carolina AHEC system, I think one of the things that they go to all the time is the bottom line. So, while money is not everything that drives healthcare to be able to have a sustainable practice, you really do need to realize the financial benefits of this model. So if you don't have competitive reimbursements, reimbursement rates, or opportunities for shared savings in these value based agreements or quality incentive payments and access to other advanced payment models, then you don't have the revenue that you need to be able to sustain your organization and the healthcare practitioners and the healthcare team in those organizations have the resources that they need to deliver the quality of care that you really want for your patients. So that's the next thing they really want a CIN that's focused on patients and the care and the patient experience. The other thing that they're looking for is the data and the analytics support, because you really do need those data insights. You need to be able to identify what's your low hanging fruit. Where do you need to put your resources? And where like what are the things that you need to focus on to be able to identify gaps in care and approve efficiency in your workflows? Also, they're looking for a care management partner one that's going to collaborate with them and not just do the care management in a vacuum, but really work collaboratively with the local care team and understanding the needs of the patients and the resources that they need in managing those complex patients and have tools at their disposal for identifying care transitions and communicating with the care team whenever these patients are accessing care across the care continuum. The other thing is they need practice support. They need the education and insights and assistance in helping them understand the regulatory compliance environment that they're in the quality and reporting requirements and any other contractual requirements that they're obligated to meet their service level agreements or SLAs. Most importantly, I think is also alignment with their values. So, identifying that there's a shared commitment to improving patient outcomes and that the leadership in both organizations value collaboration and input from providers, and that the care team and the organizations that they support. And then of course technology's a big thing. They want one platform, or at least one source of information. One of the things in value-based care now you have multiple CINs for various different contracts and so you might have one for Medicare, one for Medicaid. I think in my work with practices as an AHEC practice support coach, I come to realize quickly that they want one system. They want one population health management system that is easy to understand and provides them with the insights that they need at the point of care. Providers they value CINS that not only address the immediate needs of their organization, but also position themselves for long term success in this ever evolving health care landscape. And I think going back to my first point is that they really want an organization that empowers the providers to focus on what they want to do, which is patient care and help them navigate the complexities in the value based models, but really allow them to do what they do, which is provide patients with quality care.

That's a big menu of ideal resources that that are expected from a CIN. So, I guess then my question is it obviously some independent providers aren't getting all of those benefits, yet they still feel still feel hesitant to switch if they are within a current CIN. Why do you think this reluctance exists and what factors might be at play in those decisions.

So I think providers are reluctant to change for a variety of reasons, and one is basically, it's better the risk you know versus the risk you don't know. So, they already have these established relationships with their current CIN and whether they're long standing and trusting, it's familiar for them. And also, there's the perceived risk of transitioning. Concerns about like, how is this going to disrupt their current operations or learning a whole new system or adapting to new unfamiliar workflows. Also, there's an unclear risk benefit, so they have difficulty in evaluating what the risk benefit is in determining what the if the benefits outweigh the risk of transitioning away from their current CIN. And then of course they're contractually obligated or maybe contractually obligated in their existing agreements and so there may be some complexities about switching and how tightly they've aligned their financial ties to their current CIN, and I think a big thing is they want to know that the organization that they're, they might be moving to aligns with them culturally. So, does the CIN value the same things as the provider? Is the CIN's mission and leadership approach something that aligns with their approach to healthcare and ensuring that their patients get the best care and it's not just about financial incentives for the CIN. I think to be able to move providers along that continuum and to be able to enjoy a new relationship that would benefit them and benefit their patients is, you know, having an effective communication conduit for communication and then just understanding what their hesitations are and addressing those hesitations like 1 by 1.

Interesting. So, let's play a role-playing game here for me. So, pretend that I'm a provider and I'm considering a new CIN. I don't really like where I am with my current partner. What factors should I consider and how can I ensure that I'm making the best decision for both my patients and my practice?

So, I think that one of the biggest decisions that you make in evaluating a CIN is like we talked about earlier is alignment with your practice goals. So, what are your goals as a practice and as a provider? And then what you need to do is assess whether the CIN is focused on those same goals, you have shared goals, shared vision, and shared alignment of where you want to go. Understanding that the focus is on value-based care and quality improvements, but it also is centered around patient outcomes, the patient experience and then also the provider experience and the care team experience. Then secondly, thinking about what support services that the CIN offers, so what resources do they have to assist you in making the switch or moving to a different CIN. So do they have payer negotiation resources to help you with negotiating contracts if you need that. What data analytics are available? How successful has their care management care coordination program been? Do they have pharmacy support services? All kinds practice support services? What support services are available? And then thinking about like their financial the financial implications in the payment models like what do they offer? Do they offer upside risk contracts, downside risk contracts or full risk contracts? What are the shared savings opportunities and potential costs associated with being in this CIN and understanding what the financial implications are and how that would benefit your organization? And then I think culturally thinking about again, does this does their mission align with your mission? Do their values align with your core values? How does that culture impact your patients and impact their continuity of care improvement in their patient outcomes, their patient experience? Really just thinking of it from a holistic point of view and not just from a financial point of view. I think a lot of people who are thinking about or entertaining a change in CIN they the first thing that they look to is the financial implications and maybe they don't evaluate all of the other aspects that are going to really help them realize the care that they want for their patients, the outcomes that they want for their patients, the value that their patients receive from being in the CIN and then the value that the providers and their care team are going to receive from being in this new CIN.

So Tammy, CHESS has a strong reputation and value based care, I think that's pretty well established. Could you share some of the specific supports that we have available? And can you tell us what makes CHESS uniquely suited to help providers achieve success in value-based care arrangements?

So I think chess has what I would entitle like a flexible yet comprehensive and transparent model that enables providers to be successful in this move to accountable and value based care for all patients, not just certain payers. So, CHESS offers support for traditional Medicare, Medicare Advantage, Medicaid commercial and even uninsured populations. They do this through a suite of technologies and service supports through delegated care management, pharmacy supports, quality improvement, practice support, contract negotiation, we talked about earlier. Basically, CHESS meets the providers where they are on the accountable care curve. So we have providers who are still in that learning, investing or aligning and we hope eventually we'll get to transforming. But really CHESS is able to support them where they are and to help them meet the needs of where they are in that accountable care curve and in this value-based landscape. So, I would say CHESS offers a solution for your entire patient population and for your entire organization. So, our solution supports your providers, it supports your care team, it supports your patients and really trying to figure out like how to maximize the financial benefits of taking advantage of these economies of scale and aggregating and distributing the cost across all the payer populations and I think probably if I were to say Why CHESS? I'm going to put it back to the mission vision and values. And that's like CHESS’ mission is to sustainably transform the healthcare experience for not only the patient but the provider and the care team and we do that through cultivating this value oriented, compassionate and health aligned care community and centered around our values of collaboration, innovation, expertise and integrity. And if, as a practice administrator, I think I would choose CHESS for those reasons.

Finally, Tammy, for those who are considering a partnership with chess, what makes now the right time to make that decision?

There's no time like the present. Now is always a good time to change and if you wait for the perfect opportunity to change, you probably will never make the leap. But the landscape is prime for moving toward value-based care and accountable care and realizing the healthcare transformation that we all seek.

Outstanding. Well, Tammy Yount, thank you for joining us today on the move to Value podcast.

As always, Thomas, thank you for allowing me to be here.