Mr. Kinsley has been with the Deerfield, Ill.-based company for 12 years, tasked with establishing strong health plan and provider partnerships through strategic payer engagement. Recently, he has collaborated with health plans to implement value-based payment models.
Mr. Kinsley told Becker’s ASC Review what makes a payer strategy successful and how to create beneficial risk-based arrangements.
Note: Responses were lightly edited for style and clarity.
Question: How should ASCs be approaching payer strategy in 2019?
Stephen Kinsley: ASCs sit in a tremendous place within the healthcare space, as they are the foundation for curbing healthcare costs by providing a quality, cost-effective environment for surgeons and the consumer. With that stated, ASCs should be laser-focused on creating partnerships with health plans based on value. It is critical that the value goes beyond simply decreasing health plan cost. The value needs a consumer component that ensures they are receiving premium quality services with a minimal out of pocket.
Q: How do you establish a collaborative relationship with health plans to implement value-based payment models?
SK: A value-based model is not just a math or analytic exercise. A successful value-based model requires the healthcare provider and health plan to have trust between each other, which takes time to develop. When developing value-based programs, it is imperative the program focus on quality and the consumer/member. The ASC and health plan need to focus on synergies based on understanding each other’s respective businesses.
Q: What tools and strategies should ASCs have in place to succeed in risk-sharing arrangements?
SK: Risk is a word that can be defined differently and [it’s] imperative that the ASC and health plan clearly ensure they have “stacked hands” on the definition. The most successful risk-sharing arrangements are rooted in quality, and the ASC must have a strong partnership with the surgeons, anesthesia group and other post-acute providers. In addition, not only is a solid analytics team required to ensure all parties understand the impact of the risk program, but also a clear communication plan with defined touch points to ensure everyone is informed on the progress of the programs.
Q: What obstacles have you encountered with regard to payer and provider engagement in risk-sharing arrangements? How did you address those challenges?
SK: [As mentioned above], risk is defined many different ways, and I think this can be an obstacle. I don’t think the health plan or ASC disagree that a value-based risk agreement can be successful; however, the slicing of the pie can create a substantial headwind, and I find many agreements “end” at this stage. Overcoming is not always easy, but I like to keep all parties cognizant that a risk model brings ASCs additive volume, decreases health plan cost and is based in quality.
Interested in participating in future Becker’s Q&As? Email Angie Stewart at astewart@beckershealthcare.com.
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