Our very own Dr. Andy Halpert talks about taking back the healthcare delivery system.
While the debate rages on about who should pay for healthcare, and how, there’s no argument that the care our medical professionals provide is more sophisticated than ever. And the same is true for how that care can be delivered to those who receive coverage through their employers. A wave of innovation in health benefits is helping companies take better care of their people and their bottom line. That’s why we’re dedicating the next couple months to talking to experts about the latest trends, and how benefits leaders can take advantage.
Our first industry insider was easy to get on board because he’s already on board here at Collective Health. So we didn’t have to go far for insights from one of the most experienced voices in clinical models and employer health strategy, Dr. Andy Halpert. A seasoned physician and benefits consultant, Dr. Halpert joined our team earlier this year as senior director of clinical and network solutions. For decades, he’s been helping employers with population management, provider networks, quality of care, and a lot more. Here’s what he had to say about some of today’s most talked about innovations in healthcare delivery.
Before we jump in, can you tell us a little more about your background?
I’m a physician by training. The bulk of my practice time was as a primary care internist at Harvard Community Health Plan, where I ran the group’s hospital-based programs at Brigham and Women’s Hospital. I was at Blue Shield of California for about 10 years, and spent the last six years at Willis Towers Watson focused on health benefits. My clients were large, self-funded employers from about 5,000 to 100,000 employees. I worked on healthcare strategy — evaluating medical carriers, looking at metrics and reporting, auditing health management programs, and defining strategies for everything from wellness to new delivery models.
Have you worked with employers moving toward ACOs?
Some of the larger companies I worked with were interested in onsite healthcare delivery and/or direct contracting with accountable care organizations (ACOs). Those projects tended to be very long and complex — usually a year and a half, two years. I always saw it as employer groups taking back the delivery system. Because they’d either procure the provider network, like with an onsite clinic, or in the case of direct contract ACOs, they were able to influence standards and outcomes. There aren’t a huge number doing it so far, but it’s starting to get a lot more attention.
There are a lot of interesting innovations for smaller teams to explore and, contrary to popular belief, you don’t need 30,000 employees to adopt the newest trends.
Why are we starting to see directly contracted ACOs get more traction?
Mainly because they offer the potential to manage costs and drive toward better outcomes, so as an employer you can stretch your health benefits investment further while also giving your population access to better care. A lot of it has to do with the value-based payment models that ensure you’re paying providers for an entire episode of care with a successful result, rather than a traditional fee-for-service arrangement that incentivizes transactions instead of the right outcome.
What kind of employers are a good fit for pursuing an ACO?
Size, geography, and a long-term organizational commitment all matter; your C-level execs are going to need to buy in. Entering into a direct contract with a provider delivery system takes a lot of time, money, and effort. So you have to have the resources to support that. Then there are financial and quality outcomes — size comes into play there because you can’t measure results in a credible fashion if you’re too small. The usual rule of thumb is that an employer group would have to have about 5,000 members. Geography is important because if they’re spread around the country it’s not going to work too well.
What’s your advice to employers about managing expectations around an ACO?
To get true outcomes, it takes about a year and a half after it goes live to get a good handle on any quality or financial metrics. You have to wait for your members to use the network, and then claims lag, and then you need time for all the number crunching. And that’s just year one. Sometimes things won’t look fantastic at that point. I used to counsel my clients that they shouldn’t do this if they’re not thinking about a three- to five-year commitment.
What options are out there for smaller employers, or even large employers not ready to make the jump into direct contracting?
Creating your own ACO isn’t the only option for an employer looking to gain more control over their health spend and the quality of care their population receives. There are a lot of interesting innovations for smaller teams to explore and, contrary to popular belief, you don’t need 30,000 employees to adopt the newest trends. I have experience helping a group of smaller companies, from 500 to 3,000 employees, who combined forces to implement a full-service nearsite clinic that their populations shared access to. This is a great example of finding a shortcut to adopting an innovation many think is reserved for the biggest companies. Another pathway is exploring the ACOs offered by health plans. This is an area employers need to do their homework on, but there are a lot of possibilities.
What do you think this landscape will look like in another 5 to 10 years?
I think in three to five years there will be a lot more of these direct contract ACOs, and the size of the employer adopting disruptive models will get a lot smaller. I’d expect more and more experimentation in the short term and, down the road, more standardization around a baseline of how these models should work, be measured, and what we should all expect from them.
