Ep 14 – The Tipping Point for Value-Based Care, with Tyler Wilson

What this episode covers

Today’s episode follows Austin Regional Clinic (ARC), a large multi-specialty medical group that serves over 500,000 patients in Austin, Texas. Founded in 1980 as an HMO, ARC is coming full-circle on their journey in value-based care as they now serve more than half of their population in value-based contracts. Tyler Willson, VP of Population Health and Clinical Quality talks with us about the tipping point for value, ARC’s strategy during and post-COVID, as well as partnerships with payers. We also explore Austin’s unique market where corporate giants like Apple, Tesla, Amazon, and IBM are turning the area into a hub for innovation, which offers a unique opportunity for ARC. Find out what will happen with Medicare Advantage plans in the market, how analytics and automation are enhancing care, and how an important partner is making it all possible for ARC to be a leader in the race to value.   Bookmarks: 4:01 Reaching the financial tipping point in health value 5:24 Austin Regional Clinic’s value-based care journey 8:28 Tyler describes ARC’s current population health infrastructure 9:08 The shift of payment environment towards full- and delegated-risk models 10:25 Sourcing capital and investments to build infrastructure 10:45 JV with Agilon Health (a PE-backed company that supports ARC in taking fully delegated, capitated risk in Medicare Advantage) 11:35 Evaluating the landscape to determine strategic planning horizon, scope, and scale for VBC portfolio 12:00 How the increased level of involuntary risk will necessitate strategic investments in enhanced care models 12:35 Lessons from COVID-19 in determining the “true” risk in ARC’s revenue portfolio 13:40 Shared Savings are critical lifelines in the COVID era 14:40 Austin, TX as an emerging national innovation hub 16:04 “so much of an organization's capacity for innovation comes from what it believes” 17:00 Competition for workforce talent in Austin 17:30 How to design and implement patient satisfaction surveys to collect meaningful data 18:53 Austin as an “innovate or die” type market 19:35 An outline of poor public health measures in the state of Texas 21:04 ARC’s commitment to patient access as a bedrock principle 24:05 ARC’s holding true to its value proposition during the pandemic crisis 25:11 Ensuring patient access to telehealth 26:00 Creating a patient-centered care medical home by focusing on patient access 27:10 An overview of ARC’s quality measure performance 29:00 ARC’s focus on automation, predictive analytics, and extensive outreach to ensure successful closure of care gaps 33:45 The use of ML and NLP in algorithms to drive automation in burden of illness documentation 36:22 Predictive analytics as the “unicorn of our industry” 38:00 Development of a Medicare Advantage strategy in partnership with Agilon 41:30 Incubating the types of infrastructure to test innovation viability for managing full-risk MA 42:31 The importance of an investment partner in ARC’s expansion of its full-risk MA portfolio 43:00 Market growth of Medicare Advantage being driven by consumer price sensitivity 45:00 Capturing accurate documentation in the burden of illness to the highest level of specificity 46:30 Advocating for CMS to include audio-only visits as a means to document and revalidate HCC codes 49:30 An overview of ARC’s participation in Medicare ACO program with Ascension Seton 50:58 Evaluation of the Direct Contracting ACO model