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What it takes to build a successful value-based model — 4 Qs with Surgical Care Affiliates' payer engagement leader

Stephen Kinsley is vice president of payer engagement and strategy for Surgical Care Affiliates, which comprises more than 215 surgery centers and 8,000 team members, making it one of the country's largest ASC management companies.

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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