Andrew Molosky, the president and CEO of Chapters Health System, is keenly aware of the struggles that coincide with turning a large health care provider organization into a value-based one.
The first priority in that situation, in his mind, is making sure that the entire organization is on the same page in terms of what value-based care really means, he told Home Health Care News last month at Home Care 100 in Scottsdale, Arizona.
“I think the first relationship that you must establish is a pretty good internal harmony with your employee base, your stakeholders, your governance structure, whatever that might be,” he said. “Because nothing will waylay an organization faster than when you have people feeling the priorities differently.”
The Tampa, Florida-based Chapters Health System is a community-based nonprofit organization. It provides a range of home-based care services to about 120,000 patients.
It has been approaching value-based care as a priority for quite some time now, and with urgency.
The reason for that goes back to something Molosky said back last summer. There’s a concern that providers in home-based health care – who deal with regulatory hurdles and rate cuts – will be beaten out in the value-based care game by outsiders who are immune to those issues.
“The amount of red tape and nonsense that we deal with – whether it’s in personal care services, traditional home health, hospice – it’s really a rate-limiting factor for many of us,” he said in June. “But I see these non-traditional models as people coming in from the outside and seeing the access that we have, the capabilities that we have to care in the home and the innovativeness that our caregivers provide at the bedside. Then they’ll take that and repurpose that asset outside the original construct.”
With that in mind, Chapters has hit the ground running. But despite the clinical and financial changes that come with converting to a value-based care setup, Molosky still sees that “employee engagement” piece as the most crucial – and perhaps the most arduous.
“Some view this as a margin game, others as a volume game,” he said. “Some are all about the size of your footprint, others are in this for publicity. But the first and most pivotal relationship is employee engagement.”
For now, Chapters wants to maintain a long-term view on value-based care.
But it still needs “wins” in 2024, meaning that it is prioritizing value-based care programs in its network that it believes could be stood up and successful in shorter order.
“We can have multiple paths concurrently and see which one materializes first,” Molosky said. “So it’s not the lack of predicting, it’s almost about being ready for anything and the first one that presents itself, [going for it].”
While Chapters has an array of home-based health care assets itself, it still looks for reliable home health providers to partner with.
One of the key things it looks at when searching for home health partners these days is a commitment to value.
“What is the mission of the organization, right?” Molosky said. “If it is purely volumetric, that doesn’t necessarily jive with our organizational stance. We are a quality-over-quantity organization building towards risk. And in doing that, it’s not all about how many visits you do, how many episodes you do.”
Home health providers, in general, have begun to move away from volume-based metrics since the onset of the Patient-Driven Groupings Model (PDGM). But old habits die hard.
The second key is clinical acumen, but that’s always been a part of the evaluation.
“The more you get into total cost of care, risk, quality-driven models, that clinical acumen is infinitely more important than the margin even, because the margin is not generated in a transactional fashion,” Molosky said. “The margin is generated by delivering optimal clinical care and reducing costs. So if you don’t start with those two things – a focus on value and exceptional clinical acumen – it doesn’t matter how good your downstream steps are, you’re still going to have lost before you started.”
Ultimately, the goal for Chapters is to treat patients holistically, and view all of its patient care services – whether home health, hospice, palliative, or primary – as part of a larger risk- and value-based ecosystem.
“You want to get to the point where you can manage populations in the home,” Molosky said. “That becomes a parlay to reducing ER spend in a full-risk environment. It becomes earlier intervention for a hospice or home health episode. It becomes a better transitional experience to a PACE center. Any of those natures, that in and of itself, as long as you’re not losing your shirt, that begins to feed the system as a larger, true chronic illness management system and not parsed out services.”
