Risk and Reward in Collaborative Care

Margaret Dick Tocknell, for HealthLeaders Media , April 15, 2013
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In addition to anxiety, there are trust issues. Indeed, 14% of provider leaders pursuing collaborative care say their primary roadblock with payers is lack of trust.

"If providers take on risk, at the end, will they save money?" asks Joanne Roberts, MD, the chief medical officer for the 491-staffed-bed Providence Regional Medical Center Everett in Washington. "There's a lot of skepticism."

Providence Regional has a long-term collaborative care relationship with the Everett Clinic, a medical group with 400 physicians and 16 locations in the Puget Sound area. Still, Roberts says her CFO often talks about how the medical center lives in a primarily fee-for-service world in 2013. "In 2014, we'll probably live in a 50-50 risk world and in 2015 maybe we'll live in a 70-30 risk world. Then it will be an obvious improvement. But here's where we are stuck. We know it's the right thing to do, but moving in that direction probably means a new loss today."

"It's the crux of the challenge in the healthcare industry today," Roberts states. "Who can survive the losses that will come until the healthcare system rights itself? Given the timeline we face, I worry that the only institutions that are going to succeed will be either upstarts that are highly innovative or stalwart healthcare companies."

That's why Kennedy says payers must do their homework. "They have to create the return for providers. No one is going to invest in collaborative care without a financial return. You can't just say collaborative care is a good thing and you should do it. There has to be a business model that creates the financial wins to execute those strategies."

Despite their risk reservations, among healthcare leaders actively pursuing or in the early stages of collaborative care development, the most mentioned reimbursement models expected to be in place within three years are bundled payments (56%), commercial payer contracts (55%), and the Medicare Shared Savings Program (46%).

Margaret Dick Tocknell is health plans editor for HealthLeaders Media. She may be contacted at mtocknell@healthleadersmedia.com.

Reprint HLR0413-3

This article appears in the April 2013 issue of HealthLeaders magazine.

Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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