Tufts Medicine, an integrated health system in Massachusetts recently announced a partnership with population health company Navvis to accelerate the adoption of value-based care. St. Louis-based Navvis also recently named Courtney Fortner its new president and CEO. She recently sat down with Healthcare Innovation to discuss how her company works with health systems on care transformation.
Healthcare Innovation: Congratulations on being named CEO. Could you tell me a little about the history of Navvis?
Fortner: Navvis was founded in 2004. Mike Farris, our previous CEO, is now focused on our parent company, Surround Care. I would say our business model has drastically changed. Navvis was a consulting company for some period of time. There was a point at which Mike went to a company called Healthways and brought Navvis in as a subsidiary. At the end of 2015, he pulled Navvis back out, and that's actually the time that I joined the company. To me, that was the inflection point, the pivot from a consulting company to an operating company. That's when we really started to become what we are today — not just giving a playbook and leaving, or doing an assessment and leaving, but really being an operating partner with our health systems, health plans, and physician groups.
HCI: I read that one of the health systems that Navvis has worked with is SSM Health. Could you perhaps use them as an example to talk about some of the challenges they face in the transition to value-based care? What are some of the things you work on with them?
Fortner: We actually went live with our partnership with SSM Health in May of 2020 right at the start of the pandemic. There was quite a bit of debate around whether we should be doing this. But there was no greater time in terms of the world needing value-based care than during the pandemic. So we made that decision to go live, focused in our St Louis market. We’ve expanded to Wisconsin, Oklahoma and Southern Illinois as well.
Our partnerships are very much operating partnerships whereby we are providing care management across the care continuum. We think about acute, post-acute, and ambulatory care management, and even in the home.
The other piece that really serves us well is our peer-to-peer physician education and training. We have a program called practice optimization, which is really boots on the ground, working with physicians and their practices and their staff in making the pivot from fee-for-service to value. I mean, that's the struggle for any health system and so SSM is no different there. Starting out, I think the compensation model was very conducive to fee-for-service. We did a lot of work to redesign that and implement a new primary care provider compensation model. We provide technology on top of that, analytics, market economics and really continuously assessing where are the high cost drivers, what's happening from a clinical standpoint? We go into the physician practices and do some change management there, but support them in a way that is not doing something to them, but doing it with the physician.
HCI: Do you often come into situations where some of the physicians are employees of the health system and some are not? And does that make a difference in terms of how engaged they'll be?
Fortner: In most all of our partnerships, we have a set of employed physicians, and then a clinically integrated network, which is comprised of mostly independent physicians. And there's certainly a difference when you think about again comp models. When you're independent, you see those results of shared savings that you generate. They come directly to you. At the system level, it is a little bit different, right? The physicians are like, I know I'm doing these things to get upside, but where's it going? So something that we've doubled down on is messaging and communication, so the physicians understand where it's going; it’s going to build this ecosystem that supports you and your patients. Going back to the PCP comp design, we move that from just a pure RVU model to start to incorporate value-based. Now, it takes time to do that and get buy-in to do that.
HCI: Navvis recently announced a partnership with Tufts Medicine, which is an integrated health system in Massachusetts. What are you working on with them?
Fortner: Historically, Tufts Medicine has had success in risk contracts. Our work with them is really scaling that across the system and across the state. That’s our vision there. It is an interesting market where there's a lot of disruption, but it's necessary disruption. The costs are extremely high. There are players coming into the market, picking off primary care physicians.
HCI: So is most of your work focused on the primary care providers or is some of the work with specialists too? Or is that more challenging in some ways?
Fortner: Most of what we do is focused on primary care. We do see the primary care physician as the quarterback for the patient. I mean that is who the patient trusts. Specialists play a really big role in value-based care, obviously, from a cost standpoint. We stand up and manage what we call preferred specialty networks, and that comes with a set of criteria for those specialists that is really conducive to being a high-performing, high-quality, cost-effective provider. We also have some programs around specialty pharmacy. We know that drug costs are particularly high, so ophthalmology, for example, is a focus for us in the pharmacy specialist space.
HCI: Do you also work on issues of data sharing and transparency?
Fortner: It's a big part of what we do, from a capability standpoint. One of the first things that we look at is, what do we have in terms of reporting? What do we have in terms of analytics? Because those are kind of the root, the foundation of what's driving change management in the practices, what's driving transparency for how they are performing. So we have a whole process for ingesting the right data, getting the right data from our payers, certainly not an easy feat, but I would say we spend considerable time and effort, and have quite a bit of expertise in that area, to get that right with our partners.
HCI: How do you decide which markets to expand into. Does it involve state regulatory issues or market forces? Are commercial payers more open to value-based care arrangements in some regions?
Fortner: We really look for a couple things, Primarily, market share; more importantly, collaborative IQ, I would say. We’re looking for partners that are committed to really transforming how care is delivered. I think companies like ours often preach about value, and it's like 'value is good, volume is bad,’ and so you've got to shift from volume to get to value. We passionately believe that you can and you should have both value and volume as a system. You should have volume-based growth through value based care. So our work is not just in the value-based contract space, but it extends to the acute setting from a throughput and capacity standpoint. So as we decompress the acute chassis and then appropriately manage those patients from a value-based care standpoint, we really have the convergence of volume and value.
HCI: What are some of the challenges in coordinating with the post-acute care setting? Is it hard to get visibility into what's going on there, or sharing data there?
Fortner: I think for systems without a partner, it is. Our approach is to go into a market and stand up or optimize a high-performing post-acute network. So we're looking at those SNFs and those home health agencies, assessing them using our methodology, and then we're actually putting them under contract to say, this is the care model. This is what we expect from a length-of-stay standpoint. I think historically there are staffing challenges, labor challenges, within the SNFs. And frankly, SNFs hold on to their patients because they don't know where the next one is coming from. So we've seen a lot of success in this space by saying to them, ‘you're part of this preferred network. You're going to get patients, so don’t hold on to them for that reason, because as soon as you discharge one, rest assured, there's one coming behind them.’ We have seen tremendous success, I think, in this space, because we've been in the post-acute space for so long.
HCI: From your perspective, are you fairly pleased with what CMS and CMMI have been doing as far as payment models, or are there things you'd like to see them do differently?
Fortner: I think probably the big buzz around what CMS is doing involves V28. That’s the new HCC coding model and it has a substantial impact. I am supportive of the intent, which is to catch those who have been playing the coding game, but the method through which they've done it is actually going to hurt physician groups that are doing it for the right reason, which we refer to as early disease recognition. That piece I am not thrilled about, but we've got it for the next three years, so we've got to figure it out.
We're not a niche company. We work across all lines of business, so we have just over 3 million lives across all lines of business and all payment models. So we're never going to just go in and manage a bundle or an MSSP ACO, but putting those in the context of the rest of what we manage, we've found great success in those. And I think the intent is right; they just take some refining.
HCI: And are you finding that the the commercial payers in a lot of states are being innovative also as far as value goes?
Fortner: I do. We've got some great relationship with payers. We partner with health systems and health plans. Our biggest book of business is commercial, as you might expect. We're kind of at this inflection point in general with payers and how they view the world. But I think we're coming across some pretty enlightened payers. Those that we partner with understand that what we're doing is going to help everyone, all lines of business, all payers, all providers.
HCI: We hear a lot of people in the provider space calling for more quality measure alignment across payers. Have you seen any movement or progress on that multi-payer alignment front?
Fortner: In the absence of an overarching strategy, no. But we bring our payer contracting strategy team to the table. By way of having good performance and being able to point to it to say, This is why we want to do it this way, the payers are far more receptive. There was a time a while ago where we would, talk about a technology platform, and we would say, Oh, we have 500 quality metrics, and it's so great. Now, we don't want to have 500 quality metrics. We want to brag about getting your payers to only have 10. I don't think it's pie in the sky. I think we really are advancing toward and progressing toward that approach.
HCI: Is part of your ongoing work partnering with groups that may not have much experience taking on risk and helping them go through those contracts and understanding them and getting more comfortable with that?
Fortner: That's right, and not everyone will be ready for risk on day one. So one of the first things that we do is a five-year financial model. We look at where are they today. What does that journey look like? Again, what can we do on the volume side, as we're looking at that risk-based journey, and have a strategic approach there? Not all our partners will be ready on day one for risk, and there are many times where we will step in front of them to take the risk, but it's all about pacing and sequencing and market dynamics.
