Jason Helgerson, chief solutions officer of Helgerson Solutions Group and former Medicaid director for the states of New York and Wisconsin, will be a featured speaker at the National Population Health Summit, Nov. 12-13, in Orlando. In this article, RISE talks to Helgerson and his co-presenter, Juliette Price, solutions architect for the social determinants of health, Helgerson Solutions Group, on trends in value-based payment (VBP), population health, and social determinants of health (SDoH).

Helgerson is an internationally-recognized leader in public sector health care following his work in New York, where he led the overhaul of the state’s $68 billion Medicaid program and led the move to value-based payment. The initiative reduced spending by $17 billion over the first five years, improved quality, and protected member benefits. He now advises health care organizations across the United States on how to create effective VBP strategies, facilitate cross-sector collaboration, engage stakeholders, and tackle SDoH.

He and Price will join Sander Koyfman, M.D., behavioral health medical director-New York, WellCare, at RISE’s National Population Health Summit, for a session on how to take advantage of the move to VBP to deliver population-level change.

The move to value-based care

The transition to VBP is well on its way and is almost at the tipping point, according to Helgerson. But, he said, the models that organizations use today will continue to evolve and will look very different in the next five or 10 years.

“I am pretty optimistic that in five years we will quickly be accelerating to a world where the vast majority of payments to providers in health care will be value-based,” Helgerson said.

However, as organizations move from fee-for-service to VBP, there is a lot of focus on the details of the contracts, but not enough attention to the new care models, he said. Organizations need to think about what they’ll do differently to better meet the needs of patients. For example, when addressing the SDoH of patients, organizations must consider new approaches to meet these needs and provide better integration between health and social care services.

“One of the things that we are preaching is the need to prepare, because really when you are going in to upside-downside arrangements and taking on downside risk, you need to have a high degree of confidence that whatever you are doing differently is going to work and you have to have in place ways to monitor your performance in as close to real time as possible. And that leads to another theme. There is a general unease that people are underestimating the work they need to do to engage in ways that really transform care and in ways that will help them control total cost of care,” he said.

Helgerson also advises organizations and policy-makers not to view the move to VBP as a budget-savings exercise. “You don’t want to use this as a back-door reason for denying services inappropriately or cutting reimbursement rates to providers. It’s a big enough change, in of itself, to put artificial costs or pressure on it,” he said.

The need to structure payment around SDoH, population health initiatives

Price adds that as health care organizations think about the potential impact of SDoH, they must also consider the need to structure payment models for these types of interventions. “There is an outsized demand for things like stable housing, food services, mental health services, all these things we know have an impact on health outcomes, but there isn’t a super clear path for how health care pays for this,” she said.

The industry must incorporate SDoH into the move to VBP so that it’s embedded in a financial model, according to Price.  “If we want to move the dial on population health, we’ve got to figure out a way that it’s not separate and apart from the clinical side of the house. It must be part of how we structure the financing of health care in the future,” she said.

The answer, she said, can’t simply be that it’s an added cost and demand that payers figure out how to pay for it. “It has to be a combination of really understanding the ROI and understanding where the benefit is seen. And it’s also about being a good steward, making sure SDoH initiatives do deliver on impact they promise. The worst kind of intervention would be the one you deploy and you either can’t or don’t measure so you actually don’t know what impact you’ve had,” she said.

Helgerson agreed, noting that organizations must make SDoH and population health part of their core strategy. “Our fear in SDoH is that people do it around the edges, but they don’t make it core to how they operate. They make it an add-on thing they do or simply say they are addressing SDoH issues,” he said.

The good news is that Centers for Medicare & Medicaid Services has implemented changes that provide Medicare Advantage plans with greater flexibility in offering benefits that address SDOH, Helgerson said. “Plans have a whole new set of tools at their disposal to manage costs of care and it is a fast-growing market. I think there is a huge opportunity for innovation,” he said.

Helgerson said his advice is for Medicare Advantage plans to think about their 2021 bid and look for potential partners to help take advantage of these new opportunities. “Now is the time to make some strategic investments, partner with organizations, and use some of that new flexibility,” he said.

Editor’s note: RISE’s National Population Health Summit will be held Nov. 12-13, at the Omni Orlando Resort at ChampionsGate in Orlando. Click here to see the complete agenda and registration information.