Ep 16 – The New Frontier For Health Care Transformation, with Dr. Mark Gwynne

What this episode covers

North Carolina seems like an unlikely laboratory for value-based care. It refused to expand Medicaid coverage under the Affordable Care Act and ranks in the bottom third among states in measures of overall health. North Carolinians are experiencing stagnant or worsening population mortality rates and substantial health disparities, with 15% percent of residents living below the poverty line, and over one million (10% - 9th highest in the US) North Carolinians uninsured. Health care costs are rising, crowding out other state budgetary priorities and limiting wage increases. But the state has embarked on one of the country’s most ambitious efforts to transform how health care is defined and paid for. Accountable Care Learning Collaborative co-founder Dr. Mark McClellan, CMS Administrator during the George W. Bush administration, has publicly stated the “No state is moving as far and as fast as North Carolina.” UNC Health is leading that charge. Mark Gwynne, DO, is the President and Executive Medical Director of UNC Health Alliance (statewide CIN) and UNC Senior Alliance (NextGen ACO): his leadership, results, and vision for the future provide Race to Value listeners a rich viewpoint for value. The physician-led CIN unites independent and employed providers in a program that drives collaboration and communication across the health care continuum to improve quality of care, control health care costs, and work in partnership to provide coordinated care  Their recent performance has reduced the cost of care for 140,000 Blue Cross NC members, earned $17.5 million in quality and shared savings payments, and achieved a 100% quality score. The NextGen ACO is one of only a few academic organizations participating in the highest-risk alternative payment model and ranks #1 nationally for quality. Bookmarks: 3:55 The state of Value-Based Care transformation in North Carolina in juxtaposition with the state’s health outcome challenges 4:49 “North Carolina: The New Frontier For Health Care Transformation” (Dr. Mark McClellan: “No state is moving as far as fast as North Carolina.”) 7:03 “We’ve created a pretty good substrate for our payer partners across market segments where we are really starting to see the scale that we need to catalyze this kind of work.” 7:28 The tipping point for value-based care transformation of 35-40% needed to capitalize on investments and leverage the altruism of providers 8:00 The key to value-based success in NC is based on Partnership (e.g. partnering with forward-thinking payers) 8:35 UNC Health Alliance and its recent outstanding performance of $17.5M in shared savings and 100% quality score in the Blue Premier program 11:13 Dr. Gwynne discusses how Blue Cross NC is approaching its collaboration with his CIN and what the national payer community can learn about partnership with providers to transform care delivery 12:01 Transparency in calculating benchmarks and MLR and making quality targets achievable 13:54 Investing in a robust infrastructure around clinical quality improvement and establishing improvement collaboratives among primary care practices 14:23 Pivoting an internal infrastructure to focus on outcomes with appropriate patient outreach, provider education, facilitating improvement efforts in practices, and making EMR adjustments to support the work 16:25 The economic effects of COVID-19 on the PCP community and the Blue Cross NC “Accelerate to Value” stabilization program 21:17 Dr. Gwynne discusses how primary care practices should be looking at capitation in the years to come 23:15 Dr. Gwynne shares his perspective in balancing shared savings distribution to providers with capital re-investment (UNC Health Alliance distributes 80% of Shared Savings to its providers across all contracts)<br ...