COVER STORY · HEALTHCARE FINANCE STRATEGIES
Finding the Upside in Downside Risk The leaders of pioneering patient care organizations are diving full-bore into downside risk-based contracting and making it work—through a combination of key strategies, and a whole lot of determination
By Mark Hagland O
ne of the pre-conference sessions at the APG Annual Conference, held April 11-13 in San Diego and sponsored
by America’s Physician Groups, a nation- wide association for medical groups and health systems participating in value-based contracting, got to the heart of the core questions around risk-based contracting. Held on the morning of Thursday, April 11, the session was entitled “How to Move from Upside-Only to Downside Risk,” and involved presentations from three lead- ers of multispecialty groups that are at the forefront of mastering risk-based contract- ing—Adam Solomon, M.D., chief medical officer (CMO) of the Long Beach, Calif.- based MemorialCare Medical Foundation; Mark Wagar, president of the Lancaster, Calif.-based Heritage Medical Systems; and Narayana Murali, M.D., executive director and president of the Marshfield, Wis.-based Marshfield Clinic Health System, and also
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executive vice president and chief clinical strategy officer of MCHS, Inc.
“Outside of the contract, the most impor- tant element to consider is your network. Who will you include? The basis is your primary care physicians,” Dr. Solomon told the APG audience. “If you don’t select pri- mary care physicians who naturally manage patients well—who utilize properly and don’t refer excessively—you won’t be suc- cessful. Physicians won’t alter their care, so thinking about that is essential.” And he added that specialist physicians involved in one’s risk-based contracted network needed to be those who “utilize appropriately, utilize the right locations for cost-effective care, and communicate well with primary care physi- cians and patients. And the last element, of course, is facilities. You may have your own facilities that are part of the structure. But also, what is the ability of those facilities to collaborate and coordinate with us?”
hcinnovationgroup.com | MAY/JUNE 2019
Heritage Medical Systems’ Wagar empha- sized the need for strong financial planning, capacity-building, and “a culture of service, quality, and urgency.”
Adam Solomon, M.D.
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