In the latest episode of Bridging the Gap—an interview series featuring leading minds in healthcare discussing the latest innovations around behavioral health, NeuroFlow CEO Chris Molaro spoke with Lili Brillstein. Lili is the CEO of BCollaborative, a healthcare consulting firm. She is a nationally recognized leader and expert in value-based care models, and in particular the Episodes of Care model. Previously, she was the Director of Specialty Care Value Based Models for Horizon Blue Cross Blue Shield of New Jersey, and, under her leadership, the organization built the largest Episodes of Care program in the country.
Lili and Chris explored the topic of value-based care, how providers and payors can work together to successfully implement this payment model, and technology’s role in speeding value-based care adoption to improve care and lower costs. Listen and watch the full interview below and read on for top sound bites.
On value-based care:
Lili: There is a lot of miscommunication and misunderstanding about what value-based care is and the goals of value-based care. From my perspective, the goal really is how do we create more consistently good patient experiences, patient outcomes and manage limited resources over time. If you think about the prevailing payment methodology in this country, which is fee-for-service, it’s really focused on units of care. We pay for units of care, and we end up with units of care. We focus on all the care that’s rendered by one physician rather than all the care that’s rendered to one patient across the care continuum.
In my view, the term value based care and all of the models, whether they are primary care or specialty care, are really aimed at reducing those variations in care and cost of care, which require the ability to understand what’s happening across the continuum which we often don’t do today. Often physicians are working with a very limited view of what happens to their patients when they leave their office.
On the importance of measurement-based care in delivering value:
Lili: The goal has to be set around outcomes and around how do we get to the very best outcomes consistently with thoughtful use of limited resources. You can’t do that without looking at data, looking at the longitudinal view of patients to be able to see where there are variations in care and cost of care across the market or community and also within your own practice. Often there are tremendous variations, and doctors can’t see that because they can’t see the data.
I am a believer that doctors want to take good care of their patients and believe they are, but they need some help. They need to be supported. They don’t tend to have line of sight into anything other than what they do for the patients. If we’re really going to get consistently good outcomes, which will lead to a reduction in cost, we have to understand taht we have to be sharing that information.
On earning provider buy-in for value-based care models:
Lili: My theory was, and thankfully it proved out, was that if we get the doctors engaged, and we level the playing field, so they don’t feel afraid that their income is about to be reduced or that we’re about to get them. . . if we invite them in not to hear what we built for them, but to build it with us, gets them really engaged. Once they get to look at the data, for example where their referrals are going and what those outcomes look like compared to others, they make changes and they figure out how to create success in the models.
And success means: more consistently good outcomes and more appropriate use of limited resources, fewer duplicitous services. They then become more confident in their own abilities; they understand the model. They have now created a partnership with payors which is kind of shocking to them, and then they come to use ready, and they say “Now I understand how to do it; I’m ready to take on risk.” Then they move into more risk-bearing models that shift risk to the providers.
Perception is the reality we have to address. The perception of doctors is that payors are out to get them, and they don’t feel like they can trust them, and vice versa. I think creating models that are really simple at the beginning that doctors can understand, that sit on a fee-for-service chassis, and then share savings as they’re in this live learning laboratory has been a great way for doctors and payors to come together.
