Bassett CEO on Not Giving Up on Value-Based Care

Tommy Ibrahim knows there are significant operational investments tied to value-based care models, but he thinks there's still a chance for the program to accelerate.

We are going on 20 years of the value-based care model, and it is still yet to impress. As the war between value-based care and fee-for-service has raged on, many CEOs say it is still the way of the healthcare of the future.

Bassett Healthcare Network president and CEO, Tommy Ibrahim, MD, MHA, is in that camp.

As a proponent of value-based care, he says that the model is still an approach to not only bettering patients' overall health but also building stronger trust with patients and communities.

But, it’s not that easy. Value-based care requires significant capital and operational investment, he admits.

"In the climate that we're operating in right now where most organizations are operating in the red and negative margins, there's no way to invest in that capability when we're essentially trying to keep our head above water and we're essentially trying to survive," he says.

So what needs to happen? The government needs to step up, he says. In this recent interview with HealthLeaders, Ibrahim explains that with new reimbursement methodologies and incentives, there's still a chance to accelerate the industry toward value-based care.

HealthLeaders: Why do you think we should continue to try to move away from the fee-for-service model?

Tommy Ibrahim: The traditional fee-for-service model is what has been commonplace and it's what we've thrived on as an industry, forever. In my viewpoint and I would surmise also in the patients' viewpoint, a value-based strategy is the best thing for patients as a whole. This is the tension that thereby exists; the incentives are not aligned for us to migrate in the direction of a value-based care strategy and it's because in order for us to do so, would mean risking our entire livelihood as an institution.

As a healthcare organization, we operate on razor-thin margins, if any margins at all. For us to really continue to fulfill the mission of the organization, this sort of continues to fuel this volume-based mindset, which continues to pull us further and further away from doing what we feel as a whole, is in the best interest of the patient.

The volume-based approach is … where you continue to fuel visits, fuel procedures, to continue to drive volumes and revenues, by its very nature is episodic, and leads to patients feeling like they're just another cog in the wheel.

HL: How do you think the value-based care model can positively impact health system operations and create stronger relationship with the community?

Ibrahim: To be successful in the value-based model, you have to have the foundational infrastructure in place in order to assume that level of risk. That means building a core set of capabilities around analytics to really understand the population that you're managing, to be able to drill down a little bit further into some of the core root causes contributing to poor health, the core social determinants that exist, and any other unique aspects of the community that you're caring for, so that you can a targeted approach to putting the interventions in place.

If you can facilitate that infrastructure and wrap around it the necessary care management capabilities [and] patient navigation components that are necessary to guide patients through the healthcare delivery system, and optimize the risk and management of that patient's care for acute or chronic disease management, by default, you start to create a holistic approach to managing that patient's very specific and unique needs. And by that very nature, you start to move away from this episodic mindset where you're managing the acute disease to taking care of the entire well-being of an individual and engaging patients in their health journey. And that creates a relationship and begins to really instill a level of trust that you would want in a patient-provider relationship.

HL: Why is there still no wide-spread use of value-based care? What needs to change?

Ibrahim: It's all about creating the appropriate incentive models.

There needs to be a reorganized effort to approach reimbursement methodologies in a way that helps us accelerate as an industry towards value-based care.

There needs to be investments at the state and federal levels to build out that infrastructure that's required.

Right now, if you add up all of those various different components that helps to round out that infrastructure,  that's significant capital and operational investment. And in the climate that we're operating in right now where most organizations are operating in the red and negative margins, there's no way to invest in that capability when we're essentially trying to keep our head above water and we're essentially trying to survive.

So many hospitals are at risk of closure, particularly in rural healthcare. It's because they just can't sustain the very basics. They can't even equip those communities with adequate staff, let alone infrastructure, to support a value-based or population health-based strategy. There needs to be an understanding of these challenges, there needs to be a reorientation to the reimbursement methodologies, investment in infrastructure, and that begins to catalyze a very different conversation for us to drive a value-based approach.

It's hard for us as an organization to do this alone. At the heart of any value-based strategy, it really needs to be a community-based partnership approach where healthcare organizations are partnering with public health agencies, county health agencies, state and federal authorities, food banks, schools, and working alongside other employers;  really trying to leverage the core strengths of each of those various different entities to bring together a holistic strategy and approach to managing that population.

This is going to require an all-hands-on-deck approach and a willingness to think outside the box and engage.

HL: In what other ways can healthcare organizations grow trust and community for their patients and their employees?

Ibrahim: I go back to the fundamentals on this one. How do you establish trust with anyone? To me, it's very simple. It's about saying what you're going to do and then doing what you say.

As I reflect on our mission statement, our vision, our values, it's getting to the core essence of those descriptive and identifying statements. At Bassett, our mission statement is improving the health of our patients and the well-being of our communities. I think that's where engaging with the community in a big way is very important.

I have an open-door policy; I meet with patients all the time. I receive letters from patients every day and I write back to every single patient that sends me a note. Engaging at that fundamental level, that begins to create a sense that we care and a sense of trust that we're aspiring for.

Some other practical things that we've done, for example, is partnering with the school system across the community. We have 20 school-based health clinics across the entire region, which is a phenomenal program and begins to instill some credibility at a very young age with our community as well as with their parents.

We look to public health organizations as well as partnerships there to roll out free testing and screening and educational programs to inform our patients about what's most important.

Several other ways to build trust would include, being open and available to the community; executive leaders being visible presence across the community events and serving on non-profit boards and business chambers, as well as involvement in fundraiser and philanthropic efforts across the region.

Spending time with the community and understanding their major friction points and frustrations with their own personal healthcare journey is critical, and targeting very specific solutions that address those unmet challenges. And most importantly, always being honest and forthright about where we are falling short and taking steps the necessary actions to rectify any shortcomings that we might have.