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Pursuing Quality and Integrated Care

The intersection of health care delivery and management 

 

Health Care Collaborations is a podcast presented by Johns Hopkins HealthCare. Subscribe on your preferred podcast service to hear more about provider-sponsored health plans and the pursuit of quality outcomes.

Integration is more than just a buzzword in health care these days: it is poised to represent a seismic shift in the industry. Payers and providers are teaming up, realizing the health outcome and financial benefits of enhanced collaboration. Integrating health systems with managed care organizations can improve disease prevention, eliminate redundancies, and ensure efficient and appropriate utilization of services, among other benefits.

But for Dr. Marketa Wills, Chief Medical Officer of Johns Hopkins HealthCare (JHHC), integration has a dual meaning. For Marketa, the other meaning describes the holistic care of individuals. A psychiatrist by background, Marketa is passionate about treating the whole person — their physical health, mental health, and the connections between them.

“Through the shared experience of the pandemic, we all realize how critically important emotional and mental wellness is, and how fragile it can be,” she said. “Integration is bringing that concept to work. It means recognizing that our brains are attached to bodies, and that there’s so much interplay between physical and behavioral health. Whole-person, patient-centric health takes into account these factors, social determinants of health, where people live…and more.”

Caring for individuals in this manner requires a tremendous amount of collaboration. And that is where the other piece of integration comes in: ensuring that a person’s treatment is effective across the board. Using care coordination and care management strategies, the most progressive health plans place the member at the center of the care experience, assist with communication between primary care providers and specialists, and improve information sharing thereby improving health outcomes.

“I do think that is an important role that we play as payers—ensuring that integration happens, making sure that we’re incenting that, even financially,” Marketa said.

Johns Hopkins Medicine is an epicenter of research, innovation, and world-renowned care delivery. As a provider-sponsored health plan, jointly owned by the Johns Hopkins Health System and Johns Hopkins University School of Medicine, JHHC is in an ideal position to leverage that expertise and facilitate better alignment between payer and provider. This is what drew Marketa to JHHC in the fall of 2020.

“In managed care, it became clear to me that we were only going to improve the health outcomes of members if there was closer collaboration and partnership between payment mechanisms and the delivery side [of health care],” said Marketa. “So having an opportunity to come to such a great institution that has already built the payer-provider model was really compelling for me. The ability to innovate at that scale in a provider-led plan was the best way to make an impact on communities.”

To foster an effective partnership, the payer and provider need to trust one another and understand that their goals are aligned: to improve each member’s health by giving them the right care, at the right place and time, and at the appropriate cost.

“Being able to start in as comrades and colleagues marching toward the same goal allows for a more candid understanding of how we can work together for health outcomes,” said Marketa.

A medical student in the late 90s, Marketa recalls the initial discussions about paying health care providers for their patients’ positive health outcomes, rather than paying per health service. Through her career, she has been passionate about this volume-to-value shift and has seen value-based incentives begin to replace the system where providers are incentivized to conduct more procedures and tests. Leveraging her clinical experience in a management setting helps her push this idea further and devise new ways to advance the health of the populations we serve.

“I think one thing that I’ve learned is that [while] everyone’s goals align,” Marketa said, “sometimes there are competing priorities and perverse incentives that make it seem like we’re not all on the same page when we look at different parts of the value chain in the health care ecosystem. One of the things that’s very clear to me is we do want the same things, and once we begin to peel the first layer back and have those honest, open, trust-based relationships, we find ways where our incentives align and our goals align.

“It’s that kind of collaboration that brings that creativity. Being in a world class institution like Hopkins, where you’re also able to bring in the research and discovery and learn to deploy those things even faster to populations, is a great laboratory for how to think about advancing medicine as a whole. I think the payment infrastructure is so important in that, and having folks who can talk both to the clinical side and the business side is important in order to do that at scale.”

One critical area that emphasizes this relationship is the pursuit of quality. With state and federal requirements for both payers and providers, it’s vital to identify and maximize the overlaps, and understand and solve for the divides.

“We have begun wonderfully rich collaboration sessions with the delivery side, and it’s allowing them to understand what we’re measured on, why we’re measured on it, and compare that with what they’re measured on, why they’re measured on it, and find those synergy points where we can all align,” Marketa said.

Together, JHHC and providers are working to make sure that not only are the individuals they serve receiving the care they deserve and need, they’re driving toward improvements in health, in pursuit of quality-driven, evidence-based, member-centric care. Marketa said that pursuit impacts every decision.

“At Johns Hopkins, quality is something that has to be built into our DNA,” she said. “We have the resources to be able to study and understand, at the University and Medical School level, what does create good outcomes. And we can quickly translate that at JHHC into innovations that impact the communities in which we live. I’m really excited about our commitment to quality. It’s what I think about all day, every day.”

Hear more of Marketa’s thoughts and insights about integrated and value-based care, quality, population health, and more. Download or listen to the “Health Care Collaborations” podcast, episode 3.