Risk and Reward in Collaborative Care

Margaret Dick Tocknell, for HealthLeaders Media , April 15, 2013
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The top motivation for embarking on collaborative care, cited by 73% of respondents, is improving quality care. Some 91% of those who have not ruled out participation in collaborative care are at least slightly confident that the model will improve patient health, with 75% at the moderately confident and very confident levels. There's a significant rate of confidence (66%) even among respondents who have no plans to pursue collaborative care that the model will improve patient health.

At the same time, 45% of respondents who are participating in or pursuing a collaborative care model identify concerns about cost savings among their top three challenges. Ted Miller, vice president and CFO for Floyd Memorial Hospital and Health Services, a 230-bed acute care hospital in New Albany, Ind., poses the cost savings question this way: "If there is cost savings, when will it be?

"We continue to prepare ourselves from a readiness standpoint and we continue to educate ourselves around population health," says Miller, but the hospital is "still exploring its options."

Concerns about cost savings are also cited by providers in describing the primary roadblock with payers in the adoption of collaborative care. Some 24% of leaders say payers want too much gain share. Another 15% say payers are unable or unwilling to share risk, and 14% cite an inability to reach contract terms with payers. "That's just the nature of the negotiations," says Charles Kennedy, MD, CEO of accountable care solutions for Aetna. "These are complicated relationships, and so reaching terms can be a challenge."

Scott Trott, vice president of payer management and faculty services for UNC Health Care System in Chapel Hill, N.C., notes that developing such arrangements can get to a point where physicians may wonder why make the effort if "the savings they come up with just evaporates or goes to a payer's profits."

Of course, sharing risk is a basic tenet of collaborative care. At least in theory, it means that everyone along the care continuum has skin in the game and thus is inspired to work toward common goals in patient treatment, which will produce better outcomes at a lower cost. Some of the aversion to risk may be a holdover from the risk failures of the 1970s and 1980s. It is also a situation where today's realities temper excitement over tomorrow's potential. "If you were doing something that didn't cause any risk to you, it might be less of a concern. But when you hang risk on a new idea, it just raises anxiety," states Lopez.

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