Our interview ended early and I didn't include any of it in the magazine story because penetration in his area is so light, but his experience is illuminative for organizations where the commercial market seems inactive in the value-based purchasing arena.
But that doesn't mean business as usual is necessarily the smart choice, and you shouldn't think that value-based purchasing won't affect you, Schnieders says.
As for Nebraska, he and the 287-bed regional referral center, along with its corporate parent, are ready to get on with it, even though payers, by and large, aren't cooperating. Here's what Schnieders told me about how he sees the transformation, or lack of it.
HLM: In many parts of the country, payers are shifting risk. Are you seeing that in Nebraska?
Schnieders: Actually, we have not seen much willingness or movement by insurers to move into that model at all. The only payer in our marketplace that is interested in risk sharing is the worst and slowest payer: Medicaid. But we have not seen it with the dominant commercial payer in Nebraska.
Catholic Health Initiatives (Good Samaritan's parent organization) really wants to move from volume to value faster. Right now, we live in two worlds. Do I want beds filled or empty? We know there will be difficult times when we are still getting paid for volume and the volume's gone, so the sooner it happens the better. Other payers are more willing to talk about it. But they represent a pretty small market percentage here.