What “watch outs” did you think about as you received DSRIP dollars?

Michael Malick: The one thing we were very careful of was to not use those monies to cover any shortfalls in operations. That money was earmarked and dedicated to infrastructure building.

Gail Speedy Mayeaux:  When you’re a safety net provider and you’re living off of 2 and 3 percent margins, it would be easy to use that money as a windfall.

We were truly blessed that we were in a financial position through the 343B pharmacy program; the HRSA grant, all the improvements that we had made on the financial side of the house, that we could use this money and really earmark it to investments.

We were careful to not to use the money to buy computers or anything like that.

But back in the days when we were poor, that’s exactly what we would have used it for. We would have used it to clean up some of our vendor debt. When you are operating on thin margins, and you receive unencumbered money, you have to put it into survival.

We were blessed, and I think we recognize that.


READY FOR VBP IMPLEMENTATION When you step back from all of this continued investment, how has this prepared you for VBP implementation?

Gail Speedy Mayeaux:  I think we’re in pretty good shape now. I think we understand, from a data perspective, there’s going to be differences such as who payers think you treat and who you think you treat. There is always going to be this data disconnect.

So in order to get ready for VBP, without payer data – and that’s something that’s in the pipeline to arrive but that’s not here yet — you had to get your data ready.

You have to be able to challenge if it says that your colorectal cancer screening last month was 53 percent, but this month is 45 percent; don’t just say “well, that’s not that wild of a swing, it’s only 8 percent.”

Say instead, “this is a 10-year measurement and we dropped by 8 percent. There’s something wrong with that. And really challenge your data all the time. And we’ve really created that culture.

For example, we have 99 percent asthma compliance rate… and if you have somebody from healthcare, you wouldn’t challenge that number.

But having someone from outside of healthcare say I’m going to challenge that number because that seems outrageously high. That’s healthy.

I think we’ve made the investments in Billing staff so they are ready for this

I think we now have the Patient Access staff that are now ready to help patients bend that curve on avoidable ER use and avoidable hospitalizations; as well as helping people stay healthier… we’re doing right now falls prevention class two days a week; and diabetes education.

We’re also getting embedded in that prevention model and we’re living and breathing it all the time. And I think that prepares us. What would you say to another organization about VBP?

Gail Speedy Mayeaux:  Your opportunity with Value Based Payment is really for a finite time. Nobody knows exactly is that three years?  Five years? Seven years?

The VBP opportunity is that you are going to have a pool of unencumbered money because you are going to be paid in arears that you can use for infrastructure.

For us, it was really critical to say: “We have got to bake in our costs now so that when we get to a value based payment arrangement, we will have those resources that will stay unencumbered and so we can stay a step ahead of where we need to be from a financial perspective so that we’re ready.” So, we hopefully will always have the assets in place so we can respond to either the needs of the marketplace or needs of our patients.

Michael Malick: It’s critical to understand our total cost of care per patient and building the infrastructure so that as patients age or as we predict we will be caring for more of the sicker or fragile patients; we can analyze what is going to cost us to be able to provide that same level of care and be successful for these patients.

We will always see anybody regardless of their ability to pay or their condition, but we need to be able to proactively manage. Have you begun the process to engage with other key providers in a VBP arrangement?

Gail Speedy Mayeaux:  We are a member of two formal Accountable Care Organization (ACO) arrangements, and we are working with some of our peers to look at potential Independent Practice Association (IPA) development regionally.

We are a member of the Community Health IPA Community Health Independent Association (CHIPA) and a member of Upper Alleghany Health Systems Clinical Information organization that is a Medicare ACO.

SNAPCAP (Safety Net Association of Primary Care Affiliated Providers) is also looking at the possibility of IPA development. How would you ultimately describe your readiness for VBP because of the investments you have made?

Gail Speedy Mayeaux:  I think we are ready to pull the trigger.

Michael Malick: We have positioned ourselves to be ready. There is always an unknown, but I think we have positioned ourselves to make adjustments… I think we’ve done most of the ground work already.

Gail Speedy Mayeaux:  We really understand our data; using the Uniform Data System (UDS) measures as a proxy, we can deliver on quality; we’ve built out the infrastructure to the point where if you don’t make your sub specialty appointment, we’re going to follow up on it and we are going to reschedule it or find out why you couldn’t go and we’re going to get you there.

I really think we’ve put all the services we can in place. Are there future enhancements? Certainly. Have we invested every dollar completely the right way? I guess we’ll find out.


LESSONS LEARNED What can another organization ultimately learn from your experience? How you have spent a significant amount of time asking the strategic questions; looking at your mission; and ultimately, investing in the future?

Gail Speedy Mayeaux:  If it were 10 years ago, and we’re poor UPC again, and we’ve used the first two years of DSRIP funds to really stop gap; and now we read this discussion on the Millennium website, and you get that pit in the bottom of your stomach that says, “What if we’re not ready? We’ll get even further behind!”

I guess the message would be, all is not lost. There are essentially two years left in DSRIP, three years left in payment. There are private funders out there – if you’re not an FQ to help you build out your infrastructure; there are partners out there willing to share, and the SNAPCAP partners are amazing and will share whatever they have.

And if you can’t afford to invest 100 percent of those dollars; try to do 75 or 50 or even 25 percent of those dollars to get ready…and that’s at least a little bit down the road.

Lastly, I don’t think we did everything perfectly. We made the best decisions we could at the time. It was very iterative.

We’d love to tell you we sat down and always had extremely strategic meetings and identified all the staffing positions that we needed, but the truth of the matter of it is, we just continued to have informal discussions that involved the Medical Director, Clinical Operations, Care Management, Behavioral Health, IT…. We really tried to get as many of the senior leadership folks involved as possible. That involvement has ultimately been key to it all.


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