For all the activity surrounding value-based care over the past decade, health care is much further behind on value-based contracting than many would think. There are many different types of payment models which lead to inconsistent approaches, numerous metrics, frustration between the health insurance providers and care providers, and hesitancy to adopt value-based models.
When COVID hit, care providers who adopted value-based care more aggressively before the pandemic were more prepared and fared better financially. For example, they were not as impacted by cancelled doctors’ appointments as compared to fee-for-service. The pandemic created a sense of urgency for health insurance providers and care providers to embrace value-based contracts, but there’s still a big barrier to adoption: understanding contract performance. Contracts are limited by inflexible, rudimentary tools that stifle transparency between the two groups.
We can start by addressing contracting processes to make value-based contracting as seamless and organized as it should be. To move forward, we need to improve the relationship between health insurance providers and care providers. One way to do that is by making it easier for health insurance providers to engage their provider networks to collaborate on risk-based reimbursement models.
Nona Tepper, Moderator
Nona Tepper covers health insurance for Modern Healthcare in Chicago. She previously worked at Built In, Growing Community Media and Crain’s Chicago Business. Her work has appeared in The Washington Post, Smithsonian Magazine, VICE and elsewhere. In 2018, the Illinois Press Association awarded her second- and third-place in her division for innovative use of FOIA in her reporting. Nona earned her bachelor’s degree in journalism in 2012 from Indiana University, and her master’s in journalism in 2017 from Northwestern University.
Vice President, Payer Innovation
As Vice President of Payer Innovation at Apervita, Stephanie serves as a thought leader to inform strategy, working collaboratively with Product to inform the product strategy, roadmap, and design, assisting Customer Operations during product implementations, and supporting Business Development in the sales process.
She has deep experience in value-based payment models, healthcare policy, contract negotiations, and healthcare analytics. Previously, Stephanie served as Director of Network Contracting at BCBSMA & Health Systems Contracting at CVS Health. In this role, she developed the strategy, tactics, and tools for the Provider Contracting team across various hospital, physician, and health system-based contract models.
Lindsay Jubelt, MD
Chief Population Health Officer
Mass General Brigham
Dr. Jubelt is the Chief Population Health Officer at Mass General Brigham and is a physician executive passionate about population health, the patient experience, and mentoring the next generation of healthcare leaders. She also serves as the Chief Medical Officer for the Mass General Brigham’s insurance entity AllWays Health Partners. Her career at two of New York’s largest health systems, Mount Sinai and NYU Langone, has spanned value-based care, quality, and building new businesses.
Previously, she was the Chief Medical Officer and Vice President of Operations for Mount Sinai Solutions, the health system’s direct-to-employer business, responsible for bringing Mount Sinai’s offerings to large employers in areas such as on-site health centers, specialty care centers of excellence (COEs), virtual care, and navigation.
Dr. Jubelt received her Medical Degree from Stony Brook University, and completed her residency in Internal Medicine at Massachusetts General Hospital and her fellowship at the University of Pennsylvania as a Robert Wood Johnson Clinical Scholar.
Brian R. Wheeler
Vice President, Provider Collaboration and Network Transformation
CareFirst BlueCross BlueShield
Brian is responsible for leading the overall provider and network-related business functions, including the Practice and Payment Transformation Group and Provider Contracting and Network Strategy, Network Operations, and Provider Relations and Engagement for CareFirst BlueCross BlueShield.
In this role, he is responsible for leading CareFirst’s five-year transition from “Volume to Value.” He is supported in this effort by a team of experts in value-based payment models, practice transformation, data analytics, contracting strategists, and provider-relationship collaborators, dedicated to making healthcare more affordable and accessible for the communities CareFirst serves.