The Future of Value-Based Payment w/ François de Brantes of Remedy

Updated: Nov 19, 2019

François de Brantes was a keynote speaker at the inaugural VBP Forward Conference in Buffalo, NY on February 20th and 21st, 2019.

On this episode, we talk with François de Brantes, Senior Vice President of Commercial Business Development at Remedy, about the future of value-based payment. François shares with us the importance of transparency, measurement, and responsibility and tells us why payment reform is such an effective lever to drive change. You’ll hear about models that have been successful, how employers are driving change, and what you can expect from the next generation of value-based payment. In addition, François shares his insights on how we can account for the social determinants of health (SDOH) in our program design.  This section led to a significant “aha” moment for me and underscores the importance of incorporating community-based organizations (CBOs) more tightly with our traditional healthcare delivery system.

Show notes:

1:35 An introduction to Francois de Brantes, how he got his start, and how he got into measuring the quality of hospitals with the Leapfrog Group.

4:52 Why is transparency so important? How much of quality is due to observation? Does meeting quality measures mean you’re a good hospital?

“In the hospital, if a worker gets injured, that’s an OSHA reportable event. If in that same hospital, a patient gets hurt due to a safety concern, it is not a reportable event. It is a privately reportable event. Why the different standard?”

10:11 Bridges to Excellence Measures the quality of physicians for chronic condition management and creates a financial incentive for outstanding physicians. This was the first pay for performance plan in the country.

“Cross the quality chasm by building a bridge to excellence.”

13:25 Prometheus payments solves the supply side problem: the delivery system. They pioneered a new type of plan that encouraged continuous improvement of quality and affordability.

15:12 Bridges to Excellence had providers collecting data from medical records and reporting outcomes of patient care done manually before the days of EHR. Now meaningful use means we have a continuous EHR feed. Today we can collect and give physicians feedback regularly and relative to their peers.

“There’s not enough real-time feedback. Imagine an aircraft pilot, all of the measure and sensors in the cockpit give them instantaneous feedback on all the system that helps the plane stay up in the air. That does not exist in day to day physician practice.”

High performing practices have real-time continuous process measurement and they post it. Everyone in the practice understands the metrics and strives to improve them. Comparative performance to others is not ingrained in the medical profession. It’s changing but not fast enough.

20:24 Employer expectation of healthcare quality and affordability is going up! Who else in the system can help put pressure on providers?

25:55 If the power goes out, you have to wait for your electric company to fix it. There is nothing you can do at that moment about the lack of responsiveness. You have to organize and address your electric company as a group. Individual employers need to join coalitions if they are going to have a chance to influence healthcare.

30:24 Remedy Partners leads an employer coalition making an impact by approaching local providers and asking for price certainty, price transparency, and good outcomes. Employers need to know what to expect and know what they’re paying for.

35:50 You must solve the incentive problem for both providers and consumers at the same time.

39:11 What should you expect for bundled based payments on the provider side? Are historical outcomes a fair performance measure? How much financial risk can you take? When am I responsible for my patient’s health?

44:40 The dire consequences of excessively adjusting physician payments for Social Determinants of Health.

48:11 Population health used to mean public health. Stop the spread of flu, etc.  Managing the social and economic factors contributing to a chronic disease is sometimes insurmountable. Health system should think twice about taking on risk if they’re not prepared to shoulder the bourdon of getting a person to change their life. We want our patients going into the health system and for things that are outside the scope of medicine, connected to community resources to help with other parts of life.

51:42 Who are these CBOs and how do we incorporate them into this VBP model? Which organizations do we need to focus on bringing in? The answer is social equity and justice.

“It’s the responsibility of the community. As we collectively move towards more affordable and higher quality healthcare, it will hit a roadblock because it will hit up against social equity and access issues. The more transparent we are about understanding where these limits are, the better.”

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