Category: Clinical Perspective
April 26 2016
Description of this Image

Children’s Mercy Integrated Care Solutions (CMICS) is transforming the health care delivery system for pediatrics by moving from volume to value. Their mission is to improve the health and well-being of children through an integrated pediatric network that is value-based, community-focused, patient-centric and accountable for the quality and cost of care. CMICS is building a network of community primary care physicians, implementing new provider payment models for Medicaid and exploring new payment models for commercial payers.

Bob Finuf, vice president of payer relations and executive director of integrated care solutions at Children’s Mercy in Kansas City, discusses how he is leading these efforts.

How did you lay the groundwork to move from volume to value?

Children’s Mercy owned and operated a Medicaid managed care organization (MCO) from 1996 to 2012, which was sold to form our Integrated Pediatric Network, now known as Children’s Mercy Integrated Care Solutions (ICS). We maintained adequate infrastructure with the sale of the MCO to form our new model. Similar to pediatric organizations, ICS operates a network as a subcontractor to Medicaid MCO’s and a clinically integrated network for commercially insured enrollees. ICS partners with local independent pediatricians and those employed by Children’s Mercy to operate the networks.

How have you measured success? What challenges did you run across?

Our success metrics focus on the ‘triple aim,’ which includes better care, smarter spending and healthier children. One of the biggest challenges with managing population health is attempting to change the delivery model and payment model simultaneously. This is critical in order to align the incentives for all the stakeholders. As a practical matter, not all stakeholders (consumers, providers, payers, suppliers, etc.) will move at the same pace and may not be sensitive to the sense of urgency of other stakeholders.

What advice would you give to organizations who are working to make the shift from volume to value?

Our practical experience so far has taught us valuable lessons, and we’re still learning. The advice and key learnings include:

  • Change is not always well received, so prepare for pushback.
  • The organization must consider the transition from volume to value a strategic and operational imperative,
  • It’s critical to identify and engage physician champions (employed and independent) who believe in the process and can get the rest of the staff onboard.
  • Borrow everything you can from others that have gone before you,
  • Sell value internally and externally, and keep selling,
  • Market changes necessitate flexibility in strategy,
  • Make your plan, then plan to change it.

Jill C. Anderson, senior strategist, Cerner, will co-present with Bob Finuf at Becker’s Hospital Review 7th Annual Meeting on Thursday, April 28.  Their presentation is titled: ‘From Volume to Value: Building the Bridge While You Cross It.’