July 15, 2019
Stuart Baker, MD
Navvis
President Emeritus and
Executive Officer

HMSA PAYMENT TRANSFORMATION RESULTS PUBLISHED IN JAMA

In the July 2nd, 2019 issue of JAMA, an article authored by Dr. Amol Navathe, a researcher at the University of Pennsylvania, presented the results of payment transformation in Hawaii. The transformation work, spearheaded by HMSA, the Blue Cross Blue Shield plan of Hawaii, is part of a larger vision by HMSA to transform the health and healthcare of the people of Hawaii.

The results stand on their own merit – a statistically significant improvement in quality (2.3 percentage points higher) when comparing the primary care physicians who were transitioned to value-based payments to those who remained in a fee-for-service model. These results are particularly impressive given that most efforts to date to improve quality through alternative payment models “have yielded little concrete evidence of success, particularly in primary care” as noted in the linked JAMA editorial.

Even more noteworthy is that HMSA ultimately transitioned almost all of its eligible PCPs to value-based payments, marking this as the nation’s first statewide implementation of value-based payment for primary care. And recently, CMS announced new payment models to launch in January 2020 which are directionally aligned with the payment models and experience in Hawaii.

The story, however, neither begins nor ends with payment models. What’s special about the work in Hawaii is that it transcends financial incentives alone, to include the services and resources needed to empower primary care physicians. For healthcare leaders planning a transition to value-based care in their markets, the larger story provides valuable context for implementing and scaling population health strategies.

In developing the program, HMSA enlisted leading healthcare experts including Dr. Mark McClellan, Dr. David Nash, and Dr. Ezekiel Emanuel, among others, to guide the work; engaged physicians and captured what mattered most to them at every stage of program development; established governance and leadership models that included those physicians; aligned care management processes, people, and networks; and deployed technology to support the physicians as they moved to the new value model.

We are honored to be on this journey with HMSA to reimagine population health – as a thought, implementation, and operating partner. As summarized in the JAMA editorial, ‘Primary care physicians and patients are looking for ways to recapture the human elements of care: time, personalization, and dignity. Payment models should accelerate this process and not hinder its progress.’ We couldn’t agree more! Together with HMSA, we envision a healthcare ecosystem that never stops caring, and moves from asking people What’s the matter WITH you? to What matters TO you? HMSA’s noteworthy results to date and ongoing transformation work demonstrate the promise and potential for the next generation of population health.

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