Lower than two years in the past, Susan Ponder-Stansel, CEO of Alivia Care, was open and trustworthy concerning the challenges her group would face on its journey to risk- and value-based care.

Now it's nonetheless on that journey, however a lot additional. The corporate's story is a promising one, one which reveals house care suppliers can turn into risk-bearing entities with higher management over their monetary future.

“We actually imagine this would be the means you’ll have monetary success,” Ponder-Stansel instructed Dwelling Well being Care Information. “And in addition the way you handle to ship higher outcomes to noticeably sick sufferers.”

Jacksonville, Florida-based Alivia Care supplies house care, hospice care, private care, palliative care, superior care planning and different companies in North Florida and South Georgia. The corporate has its personal All-Inclusive Aged Care Program (PACE) and plans to open one other in the end.

Ponder-Stansel spoke with HHCN and its sister web site, Hospice Information, final month about that value-based care journey – and extra – at Dwelling Care 100 in Scottsdale, Arizona.

The dialog is beneath, edited for size and readability.

HHCN: What are your organization's largest focuses for 2024?

Assume – Stansel: What we're actually targeted on is championing value-based care.

We actually wish to stand behind the at-risk physicians in these REACH ACOs, or work with them and determine how we could be a companion. We have now been getting ready for this for years, that’s what we do. And it's an amazing alternative.

So you’re on the lookout for the perfect danger companions?

That's proper, and we’re already in danger due to our PACE program.

However we wish to work with them. We actually imagine this would be the means you’ll find monetary success. And in addition the way you handle to ship higher outcomes to noticeably sick sufferers.

And I feel in case you're in a value-based state of affairs, you want all of the parts: the personal duties, the Medicare-certified hospice, the grownup little one care, all of the items of that care.

Take PACE for instance. It’s a longitudinal service, there are lots of grownup packages the place contributors have been in for 10 or 15 years. You handle them to maintain them locally and out of long-term care. Now they’ll obtain intermittent long-term care after a hospital keep, however they aren’t supervised. They don't dwell there.

You want completely different instruments for this.

The challenges now are that there’s a lot consolidation taking place and there are such a lot of giant corporations with quite a lot of PE funding. We're a regional nonprofit, so that you're all the time weighing how rapidly you may get your resolution to market with out having to merge or increase extra capital. However up to now we haven't needed to go that route.

Now that a number of the cuts are going down in house care and labor prices, we’re seeing some margin compression. So we all know that the fee-for-service enterprise might be not going to get us the place we wish to go.

On the opposite aspect of the coin, with value-based reimbursement, decrease reimbursement charges could apply there as properly. How do you compensate for that?

It is determined by which value-based program, as a result of there are such a lot of flavors of that.

In PACE for instance. In Florida, Medicaid charges are horrible. That's why we haven't had a lot competitors there in PACE.

However these are double remarks. So for nearly all of those you have a look at their HCC scores. You get your month-to-month fee (your per member monthly) primarily based on their visible acuity, after which it's as much as you to handle every part, whether or not it's a coronary heart transplant or dental care.

That's the factor I like about it, Particular Wants Plans and D-SNPs and the I-SNPS, you get that bucket of cash and you can also make choices primarily based on the affected person's wants with out going again for pre- authorization.

There are each upside and draw back dangers, and you really want to have good AI that can assist you perceive who’s in your inhabitants and make sure you meet that want. The purpose is to acknowledge that danger, and never, for instance, solely present one go to per week.

We realized the laborious means about PACE, and at last have a margin there. It's yr 4. In the event you can handle PACE — since you're principally a well being plan at that time — it's actually one of the best ways to handle folks with superior and continual ailments.

How particularly do you employ AI? Are the desk stakes shifting ahead?

Sure, I feel you need to put money into that. And it’s important to be intentional about what you could do it for you.

And a part of the problem is getting the information quick sufficient.

We actually need to have the ability to stratify dangers and create a affected person profile. There are particular algorithms which you could develop to say, “Okay, if these particular issues occur, you want a further go to, you in all probability must do a medical examination.” As a result of all these issues downstream assist forestall that readmission, and assist forestall that adversarial consequence. In order that's what we're taking a look at.

With the sort of danger and value-based care that you just've now achieved, does success now result in success, within the sense that you’ve got the proof to indicate off?

Sure. That was intentional on our half to do PACE first as a result of it’s a program that has a construction, a fee system that serves the inhabitants that we wished to serve.

We thought if we had been going to leap in, we needed to discover ways to do it. And that was an excellent choice on our half.

However you do need to have a sure scale and capital to have the ability to try this in any respect.

This transfer towards these dangerous relationships appears obligatory for survival within the present surroundings. Are you enthusiastic about that chance? Or are you extra involved about it?

Each in fact. However I actually imagine that if we now have the cash and supply good, patient-centered care with out having to ask issues from [third parties]we can assist folks with these severe ailments obtain higher outcomes. And that’s the care that helps me on my means.

In the event you do it proper, additionally, you will make some margin. And that's obligatory, however actually, in case you can create that person-centered care primarily based on what you suppose is greatest for the affected person and construct a greater system, I feel that's an important factor.

As a result of it's so transactional and so fragmented proper now. You may have a look at the claims information and see what's taking place to older adults with severe diseases. And all of us lose when there’s low-quality care. So there’s additionally an altruistic motive. Moreover, I feel we'll die if we simply hold paying a payment for service.