NCH - Flipbooks

4 Are you ready for the next wave of specialty care management? To support the plan's initial market entry, the program launched with an open network aligning with primary care providers. To mitigate overuse of cardiac services, NCH implemented a cardiology quality program that mirrored the NCH oncology program discussed above. The program included monitoring members' treatments through the use of appropriate use criteria (AUCs) for cardiac services. This granular guidance assured the appropriate use of cardiac services, providing cardiologists with clear, evidenced-based direction at point of care. As the MA plan's membership reached a critical mass, NCH helped the plan transition to value-based specialty care by developing a high-performance specialty network. By implementing a capitation arrangement between NCH and the MA plan, the program improved quality while ensuring predictable costs. More importantly, by working with cardiologists in implementing financial reimbursement models, the goals of the plan and the goals of cardiologists were in lock step. EVOLUTION OF VALUE-BASED MANAGEMENT Traditional tools for cost containment in specialty care aren't working anymore, and most payers see the opportunity to move toward some model of value- based care. But where does the total-cost-of-care model fit into specialty care management, and how does it lend itself to value-based specialty care? Value-based care involves partnering with physicians to better understand the clinical tools they need to manage patients, and then employing those tools, such as quality-based analytics and benchmarking, to enable cost savings. Oncology and cardiology are the biggest specialty care cost drivers, so these care models must reward physicians for high-value care instead of high-volume care. This will require innovative payment structures and incentives for providers to deliver better outcomes. New Century Health is leading this evolution, and is seeing continued success with sophisticated, value-based arrangements that help practices reduce unnecessary variation in patient care and lower the cost of specialty care while providing higher-quality treatment for patients. By implementing a capitation arrangement between NCH and the MA plan, the program improved quality while ensuring predictable costs.

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