For the past 20 years, Amita Health has demonstrated financial and clinical success in capitation arrangements. Of the 170,000 patients in the Illinois health system, in fact, 30,000 are already under a capitation arrangement, according to Ryan West, chief operating officer for Population Health at Amita.
“This is a product that has lived in one way or another for well over 20 years,” West said. “Many of the healthcare organizations around Chicagoland are familiar with the product.”
Amita participates in commercial and federal accountable care/shared savings as well as a commercial HMO contracts. Since accepting risk from payers almost 20 years ago, West said that Amita Health has never missed a budget or failed an audit, and has seen steady increases in quality performance.
“If you look at the healthcare industry and where it’s moving, it’s no secret that providers across the country are identifying the secret sauce of the risk model,” West said. “We made the successful switch to a risk-based model. We are along the journey, but by no means have we got this figured out.”
The ingredients in Amita’s secret sauce come down to four key principles: physician engagement, clinical integration, having a high emphasis on integrated data, and making a determination on what should be borrowed, rented or outsourced, according to Amita chief medical officer Luke Hansen, MD.
“There are many vendors out there to handle care coordination,” Hansen said. “For us I tend to want clinical care to be the last thing we outsource.”
The move to risk, and value, is not going away, even under the current administration’s scrutiny of alternative payment models, they said. Hansen added that even if the new presidential administration ends the programs he does not believe commercial insurance companies will follow suit.
“At very simplistic level,” West said, “whether you take all of the policy away, our country still has a cost problem when it comes to healthcare. The only way to address that is to bring cost down.”
Hansen and West will present during the session, “Twenty Years of Risk Capitation, Lessons Learned,” slated for Weds., Feb, 22, from 10-11 am in Room W311E.
HIMSS17 runs from Feb. 19-23, 2017 at the Orange County Convention Center.
This article is part of our ongoing coverage of HIMSS17. Visit Destination HIMSS17 for previews, reporting live from the show floor and after the conference.
