The Executive Suite: Taking the Risk Out of Full-Risk Contracts

As the COVID-19 pandemic began to spread across the U.S., in North Texas, we turned to data to guide rapid decision-making. Responding to this crisis requires comprehensive, longitudinal data—and full visibility—across our healthcare system to identify who and where our patients are, what they need, and when they need it. It’s population health management 101.

But what was the real secret ingredient to effective population health in a pandemic?

An early transition to value-based care—including full global risk agreements—enabled our teams to have the necessary member insights and to respond both rapidly and flexibly while maintaining high-quality care. Withcommunity physicians and our academic and acute-care founding partners, UT Southwestern and Texas Health Resources, working side-by-side, we can track our patients from home to primary care to acute care and back again, and design interventions at appropriate points along the full continuum of care.

Within the first weeks of the pandemic arriving in the U.S., our clinically integrated network was able to care for patients and support the physicians who care for them. First, we looked at our members who were not COVID positive. We could see they were not all getting the care they needed. Emergency department visits were down for everyone except those with the virus. Data also revealed a dramatic uptick in strokes and cardiac arrests at home. The people we serve were afraid to seek care and risk exposure—even when other causes threatened their lives.

As all healthcare systems prepare for a new normal, key learnings from the COVID response of our network can guide us all forward. These actions will be vital in providing necessary and routine care until the pandemic is under control—and beyond:

Identify your high-risk members—making sure they get the care they need. If they are skipping necessary care, reach out to them, reassure them, and guide them safely back to their physicians.
Look at the rate of COVID by zip code and reach out to your members in high-prevalence neighborhoods to educate them on preventing exposure and infection.
Enable telehealth across your network as soon as possible. We were able to onboard approximately 500 independent practices in less than a month, keeping them informed, in compliance, and reimbursed. Soon, those doctors had over 8,000 telehealth visits each day. Our system went from less than 10% of physicians using telehealth to near 100%.

Keep in mind the social factors that increase risk. Concerned about quarantined seniors, for example, our teams delivered Care-at-Home Kits. These kits were filled with toilet paper, paper towels, hand sanitizer, healthy snacks, soap, and other essential items, helping to reduce their risk of being exposed to the virus by shopping for necessities. They also included educational materials with the dos and don’ts of staying safe in the pandemic.

Provide your hospitals and skilled nursing facilities with tip sheets for safely discharging and transitioning COVID+ patients. We also screened COVID+ patients for social barriers to full recovery, connecting them as needed to Meals on Wheels, ride-sharing, and other services.
Protect your community physicians from the economic shock of the pandemic by advancing part of the quality and incentive payments. We were able to advance our incentive payments in May rather than waiting for post reconciliation in the fall. This helped our physicians feel appreciated and fairly compensated for quality care and hard work during this health crisis.

The infrastructure that enabled these rapid responses to COVID also allows us to take on full-risk value-based agreements with payers and better support our physicians. For the fact is, our pandemic response would not have been possible under fee-for-service agreements. It would not have been possible if care management had been outsourced and disconnected from our analytics and processes.

Healthcare has been slow to assume full risk in value-based care models. The majority of VBC agreements are still shared savings and minimal risk and quality metrics, with the expectation of full-risk models stuck at “someday.” Yet, here in North Texas, taking on full risk enabled a multi-pronged, patient-centered, cost-effective response to an unprecedented crisis.

Because full risk value-based care isn’t just about taking on all the risk of the cost of care, it’s about doing the right thing for members—even in a pandemic. And when you have the visibility, the infrastructure, and the commitment to do that, the quality of care rises and the total cost of care drops.