Syntax Health

Actuaries are essential to value based contracting (previous blog here https://lnkd.in/egkCqRXQ), so my colleagues and I recently helped a room full of actuaries at the 2024 Society of Actuaries Impact Conference sharpen their negotiating skills with a fun mock contracting exercise. We took the group through three negotiations, all leaning on real life examples we've experienced. We struggled through how to use trust-building and transparency to reach more equitable and achievable contracts, with attendees adding their own experiences and perspectives. Thank you to the SOA team for accepting James Lucas’ and my presentation idea and to Ryan Coblentz FSA, MAAA and Keith Passwater for joining us in presenting the scenarios. 🎊 While the results of the negotiations varied, some themes were evident: ⏱️ Actuaries concur that actuaries should get involved early in creative payment model design. 🩺 When providers know their value, they become formidable in negotiating terms with payers, ACOs, and other risk aggregators. ⚖️ Health plans are amenable to adjusting the “standard model” but within bounds to avoid inequitable financial risk and administrative burden. Some session stats for the number-lovers: - 61% of attendees at the session work for health plans. - 0% of attendees identified as provider supporting. - 0% of attendees claim “expert” status in VBC experience - a stat our panelists all agreed with, since VBC is still evolving and progressing. - 2/3rds of attendees believe VBC will make up 20% - 60% of expenses by 2030, pretty far from CMS's goal of 100%

Last week, Syntax Health sponsored the Fall National Association of ACOs event, giving us the opportunity to speak directly to ACOs looking for help with value-based contracting and learn how ACOs are responding to changes, challenges, and market pressures. It was great to hear Jon Blum from CMS, to catch up with my Geisinger friends (current and former) and especially to reconnect with Dr. Gilfillan! Here are my key takeaways from Fall 2024 NAACOS - Patients are confused: Many care managers lead to unclear care coordination for patients. - ACOs have disadvantages compared to Medicare Advantage plans: While Medicare Advantage (MA) is expanding, traditional Medicare ACOs have plateaued. Variations in how MA plans and ACOs are incentivized and penalized for quality outcomes are just one area raising concerns of inequity. - Reform is needed in defining value and establishing payment terms: As Medicare Advantage grows, questions arise about true value and the effectiveness of supplemental benefits. - Lawmakers and taxpayers need accountability from ACOs and Medicare Advantage plans: There’s an urgent need for the healthcare industry to show true value, whether that is as providers of care or as payers offering supplemental benefits while posting high quarter over quarter profits. As we move forward, these insights underline the importance of collaboration, accountability, and innovation in healthcare delivery. Let's work together to drive positive change! 💪 #valuebasedcare #medicare #ACOs #collaboration #transparency

Excited to celebrate my first time attending #CPCA24AC—the California Primary Care Association’s 30th Anniversary Annual Conference! Syntax Health was proud to sponsor the coffee break, and I had the pleasure of meeting passionate Community Health Center leaders while diving into key topics impacting CHCs, like workflow shortages, shrinking margins, and sustaining healthy communities. ✨ A special shout-out to Francisco J. Silva, Esq., MBA, President & CEO of CPCA, and the rest of the distinguished panel for their powerful opening keynote which highlighted strategies for building the future of healthcare in California through protecting and improving access to care. 💡 I was also deeply inspired by Daniel Dawes, who delivered an enlightening presentation on The Political Determinants of Health and How We Can Change Them. Drawing from his new book and firsthand experience shaping policies like the Affordable Care Act, Daniel highlighted the inseparable connection between politics and health in a way that left a lasting impact. 👏🏾 👏🏾 👏🏾 Lastly, HUGE congratulations to Andrea Schwab-Galindo, MPH, CEO of Tiburcio Vasquez Health Center, Inc., on becoming the new incoming Board Chair of the California Primary Care Association We’re honored to support CHCs as they tackle these pressing challenges and earn crucial incentive dollars through equitable and innovative value-based care agreements. #ValueCHCs #HealthCenters #FQHCs #CPCA24AC #HealthcareInnovation

Driving through central PA in the fall is pretty close to top of list re: perks of living here🍂🍁⛅🌻. And last week, I got to experience it first hand as I trekked down to Lancaster for 2024’ PACHC Annual Conference! We didn’t talk too much specifically about value based care contracting, which begs the question: PACHC members, do you know if you’re leaving money on the table in your VBC arrangements? Our Syntax Health team is here to help! And as you can see - we bring the snacks 🍬🍪🍿! Key themes & takeaways: - Health equity efforts look different in rural PA vs. inner city Philadelphia, Pittsburgh or Harrisburg - but all types of CHCs are eager to meet the specific needs of their community. - Point of care innovations, like who can deliver the care and how is that care compensated, are needed as the funding options change and evolve from the state. - Improving messaging and communication are continuous development items across the clinical leadership board for many CHCs. Whether it was in the Changing Role of CFOs or the Media Training sessions, CHC leaders’ ability to deliver clear, concise and confident messaging of the value they their communities was a focal point. It was our Syntax team’s first time at this session, and honestly I had no idea what to expect. Let’s just say Pennsylvania Association of Community Health Centers didn’t disappoint! #valuebasedcare #collaboration #transparency