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Sponsored by: SOHO HEALTH
October 1, 2020

Ask the Expert: Transitioning Healthcare to Value

Lisa M. Trumble joined SOHO HEALTH as its president and CEO this past January — just in time for the start of a global pandemic — bringing three decades of experience in integrated delivery systems and physician organizations. SOHO HEALTH is committed to being a part of the solution in transitioning the nation’s healthcare system to value, she says, with payment models that make sound economic sense, offering quality and accountability. 

Lisa M. Trumble is president and CEO of Hartford-based SOHO HEALTH, a network of independent healthcare practitioners.

Q: How could the pandemic impact the future of healthcare?

COVID-19 certainly exposed the best and the worst of our healthcare system. We saw our healthcare providers and many others rise to the occasion at significant personal risk, but we also saw the fragility and fragmentation of our current healthcare structure. 

The financial foundation of our healthcare structure is antiquated; the continued use of fee for service as a payment model doesn’t work amid a public health crisis. (I would say that it doesn’t work well at all, even without a public health crisis.) Payment for services used — based solely on condition, anatomy or selected circumstances — runs counter to prevention, wellness and sound financial principles. 

Once the dust settles and we see the pandemic’s total cost to our country, individuals and employers, I believe we will experience a sea change. These stakeholders will no longer tolerate continued escalation in healthcare costs. 

Q: So what do we, as employers, employees, insurers and patients, need to do to help facilitate change?

Transitioning our healthcare system to one that treats the whole person but has individual, and collective accountability for the result is an excellent place to start. We can’t avoid the fact that healthcare is not cheap, and eventually, someone has to pay for it, but it shouldn’t be the burden of any one segment of our society. Healthcare is a human right, but this doesn’t mean any service at any time, with any provider or tool/technology. These types of choices are part of what creates misuse and overuse within our system. Healthcare services should still be medically necessary. 

Modifying the payment structure to support the correct use of healthcare services and assigning a level of accountability for the clinical and financial outcomes to each party involved in the process just makes sense. 

“Continued use of fee for service as a payment model doesn’t work.”

Q: Why do you believe that the newly introduced payment models work?

To achieve superior population health — the real goal — so much more needs to change beyond the payment model. However, the payment model is a reliable place to start. Moving the economics from fee for service to a capitated (fixed) payment for a range of services will help align incentives. However, for lasting and sustainable change, modifications to the payment structure is woefully insufficient. 

For sustainable change, our society must address all the influencers of poor health outcomes beyond individual behavior and genetics. Influencers of health also include economic stability, environmental conditions, educational level, health and healthcare access and societal conditions. Our current payment model does not focus on changing these conditions; it focuses only on the medical fix after something has gone wrong. For sustainable change, funding needs to shift from addressing medical needs to addressing all the determinants of health.

Q: What does the timeline look like for this transition, for Connecticut, in particular?

Changing healthcare is a daunting task. It will take years, but we can start with smaller changes. Changing the economic model, as described above, will help create value, or improved quality and cost. However, for continued improvements, the focus must be on population health, which will eventually address the determinants of health. Value-based care linked with population health strategies are showing promise in various markets across our country. I wish I could say that Connecticut was leading the charge, but we are behind others in this regard.

Q: What kind of momentum is needed to accomplish this complex task? 

What we need is the will for more dramatic change and tangible commitment by all involved; this is what will produce a sustainable healthcare environment. Yes, our healthcare system is complicated and challenging, but it offers so much promise to so many. Population health and value-based care are a starting point in this journey, and these strategies have demonstrated that we can achieve meaningful change.

To learn more regarding the transition of the healthcare industry to value from Lisa Trumble. Listen to her recent Race to Value podcast interview, here.