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Move to Value

By: CHESS Health Solutions
  • Summary

  • The Move to Value podcast is dedicated to helping health care providers understand and make the transition to value-based care. We do this through conversations and the sharing of innovative ideas with experts and leaders throughout the healthcare industry. Our mission is to sustainably transform the health care experience for the patient, provider and care team by cultivating a value-oriented, compassionate and health-aligned community.
    Copyright 2024 CHESS Health Solutions
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  • Maria Hayes - The Value of End of Life Care
    Apr 4 2024

    In this episode, we listen in on a conversation between Mountain Valley Hospice Senior Vice President of Strategy and Innovation, Maria Hayes, and CHESS Health Solutions Senior Director of Clinical Operations, Dr. Kim Vass Eudy, about End of Life Care, the difference between palliative care and hospice care, and how Providers can utilize these services.

    KVE: Well, thank you and welcome to the Move to Value podcast. I am really excited to bring a guest with me today. Her name is Maria Hayes. She is the Senior Vice President of Strategy and Innovation at Mountain Valley. I am excited to speak with her because in my clinical team, we are working towards bringing advanced care planning to our value partners and their patients. And Maria and I have been working kind of behind the scenes talking about this. So I really want to bring that conversation out forward Maria and I'm really glad to have you here today.

    MH: Thank you. I'm super excited to be here. Thank you for the invitation.

    KVE: I was hoping you could kind of kick this off by telling us a little bit about palliative care and Hospice care. I know as a clinician, when I make a referral, sometimes I just do a bucket referral, I say just give them palliative or give them Hospice, whichever one this patient qualifies for. So maybe you could help me understand and our listeners understand the difference between the two.

    MH: Absolutely. And I can actually start off by kind of giving you a little bit of an overview about Mountain Valley, if that will be helpful. And then I'll kind of go into Hospice versus palliative care. So, Mountain Valley is a Hospice and palliative care organization serving 18 counties across North Carolina and southwestern Virginia. We were established in 1983, so we just celebrated our 40th anniversary. Headquartered in Dobson, NC, we provide care in a large service area with six Hospice offices, 4 serious illness specialist locations and two inpatient Hospice care centers. We also have two Hospice thrift stores. We call them the Humble Hare and those stores actually benefit our charity care programs.

    Palliative care is a little bit different than Hospice care. So palliative care is a specialized medical care for people living with a serious illness. This can be cancer, heart failure, lung disease, dementia, Parkinson's disease or ALS. Patients in palliative care may receive medical care aimed at easing their symptoms along with treatment intended to be aggressive or curative. Palliative care is meant to enhance a person's current care by focusing on quality of life for them and their family. In addition to offering support to ease symptoms, the palliative care provider also specializes in leading and navigating the goals of care discussion, which we kind of referenced earlier. We help patients consider or even complete their advanced directives as well. Our palliative care providers are serious illness specialists who add another layer of support and work as a part of the patient's medical team. So that's kind of how palliative operates in, in that form or fashion.

    KVE: I was going to ask you a lot of times, I know that a patient may start in palliative care and then transition to Hospice is and I know you're going to explain a little bit more about Hospice. Is that a pretty natural transition for a lot of patients?

    MH: It is sometimes for patients. We see a lot of patients that truly can be Hospice, but they actually choose palliative because they feel more comfortable still kind of seeking their curative approaches, still seeing their medical doctors still treating their heart failure with the heart failure medications and they really kind of they're just not ready for that Hospice conversation. And but typically I would say palliative and Hospice, we really like to focus on the six months or less for their life span kind of looking at all those factors and then...

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    26 mins
  • Josh Vire, MBA, MEd., SLP - An All-Patient Solution for Managed Medicaid
    Mar 21 2024

    In today’s episode, we visit with Josh Vire, Vice President of Value-based Operations at CHESS Health Solutions, who shares his insights on managed Medicaid and how CHESS leveraged years of experience to enter into Medicaid to create an all patient solution.

    Josh Vire, welcome to the Move to Value podcast.

    Thank you, Thomas. Thanks for having me. Pleasure to be here.

    So, Josh, let's talk about managed Medicaid. First, can you tell me what is managed Medicaid?

    Sure. It may be easiest to start by sort of describing how traditional Medicaid works. In traditional Medicaid, typically this operates under what's called a fee for service payment model. This model is going to reimburse providers directly for every service that they provide to Medicaid beneficiaries. And generally the upside to this model is that it's going to allow for the flexibility and provider choice for the beneficiaries. But what we often see is that this leads to fragmented care and ultimately the incentives in this fee for service type model really incentivizes the volume of services over outcomes. So, in contrast to that, Managed Medicaid utilizes alternative payment models including capitation and what are called value-based payments. And the way that the capitation works is that a managed care organization or a MCO as they're referred to will receive a fixed monthly payment per Medicare beneficiary that's going to cover all their health care needs. And then that fixed payments are paid regardless the amount of services that are provided. And then those MCOs are going to use those funds to incentivize providers to be more cost effective in their care as well as incentivize sort of tighter coordination of the care. And then what they can layer on to those, as I mentioned, is the value-based care payments which are intended to reward providers based on the quality and outcomes of care rather than just the quantity of services provided. And so in theory, right, this would encourage more efficient, high-quality delivery of care. In addition, managed Medicaid may employ other payment models that are along that continuum of value based care payments, which could be like pay for performance or bundle payments. But really the goal there is to align the incentives to focus on driving down total cost of care as well as improving health outcomes for beneficiaries.

    Well last December North Carolina made the transition to managed Medicaid and Chess spent the year prior to that establish establishing the infrastructure and beginning to make preparations to offer this service. Can you tell me why this decision was made and a little bit of the story about how Chess built this service line.

    Absolutely. CHESS has a decades plus long history of working with providers to transform care delivery to value based care. And historically our focus has been on traditional Medicare, Medicare Advantage and commercial contracts. But as we went through our engagements with our value partners and then as we began to have discussions with providers across the state, we heard consistently that one of their pain points was the need to work with of having to work with multiple enablement companies to serve all their patients. So some enablement companies only work with MA or maybe the traditional Medicare options or commercial. But no one was really acting as sort of a one stop shop in in serving the entire patient population for these providers. So our decision to expand our services to include Medicaid was really driven by our desire to be what we call an all-patient solution, which essentially just means we want to be able to align incentives across the provider's entire patient population. And really that's because we believe this is how true transformation can and will occur, not in certain segments, but by treating all patients with an eye towards that cost containment and...

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    22 mins
  • Mark Dunnagan - Interoperability Pt. 2: Open Data Exchange
    Mar 7 2024

    In this episode we continue our interoperability conversation with CHESS Vice President of Health Informatics, Mark Dunnagan. Last time, we focused on the importance of shared data in value based care and the need to overcome any barriers. Today we talk about the logistics of interoperability and the modernization of data exchange.

    Mark, last time we left off talking about data exchange There always seems to be ongoing conversations in this topic about APIs. Do you feel like more improvement in APIs could be a potential solution?

    I do I use the metaphor of a quiver of arrows quite often when describing you know interoperability. I think you know it's my job as you know the head of a team that that must figure out how to get data and get it in a timely fashion and in a way that fulfills our contractual obligations and our obligations to the patient. I think APIs is one more arrow in the quiver. You know it gives us a programmatic way to access you know large volumes of complex data, but it's not necessarily the only way. You know when we sign on a health system let's say to one of our ACOs, you know I can pretty much rest assured that they're using one of a small number of vendors and you know those vendors are fully capable of producing certain constructs that that my team can consume. Same with most payers. Although you know, the outputs may differ certainly. But as I work my way down the chain, particularly in working with ambulatory clinics and what not, you know, I gosh last time I checked there are over 200 EMRs here in my home state of North Carolina. Each one of those with a slightly different interpretation of certain standards. Not all of them have viable API interfaces, you know, not all of them have the same way of communicating with them. So, I have to be open to old school HL 7, which is kind of the equivalent of opening up a channel and typing over it. I have to be open to flat file exchange. I have to be open to various forms of XML, JSON, and it truly depends on what that endpoint can offer. So again, APIs are extremely valuable but they're not the only tool that a team like mine has to has to be able to wield to be interoperable to be successful in the exchange of healthcare data.

    Interesting. So as someone who's spent a career in the data and informatics space, can you share how these analytical tools help control the cost of healthcare?

    There's many answers to this. I would say again I'll draw back to what we do which is value based services. You know I need to know when something happens and I need to be able to inform our performance improvement teams and so that they can communicate with the providers. I need to inform the care managers when something of interest when someone is checked into a hospital, someone has sought, you know, specialty care outside of network, when someone has been discharged, they need to know that and I need to inform them, you know, not only that it's happened, but give them enough descriptive information that they can intervene appropriately. I would go further to say that I need to glean enough good information, rather my team has to be able to accumulate and collate enough information to get ahead of what might be coming. You know, we're making some very powerful strides, you know, not only in, you know, intelligently stratifying our population to kind of know who to intervene with first, but also in quantifying rising risk and rising cost. Who do we think based on what we're seeing happen now? What do we think's going to happen to them tomorrow? And can we get ahead of that in time to affect that? Can we keep them out of the hospital? Do we know there's a costly intervention or fall coming, and can we intervene or get them some community based services in time? So, you know it's a large part of what we do and and again something that at least on the value side we have to contemplate every day.


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    13 mins

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