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Why North Texas Is Poised to Expand Episodes of Care

Collaboration between Signify Health and Aspen Physician Network are part of the move away from fee-for-service care.
Surgery Hospital Doctor
Courtesy: iStock

Signify Health and Aspen Physician Network are partnering to expand episodes of care in North Texas, realigning incentives for providers, simplifying the payment process, and saving healthcare payers money along the way.

Episodes of care are a growing trend in the value-based care world, where bundled payments include all services associated with the treatment for an illness or condition, rather than being charged for every test, procedure, or image. As the Centers for Medicare and Medicaid Services continue to incentivize providers to save money via value-based care, providers adjust and coordinate to provide quality, efficient care that doesn’t result in extra or unnecessary costs.

Because of the DFW healthcare industry’s makeup, the region is especially poised to embrace this innovation. There are still several independent primary care physicians and specialists. Those who are independent are large enough to manage their patients and the bundled payments without being controlled by a more extensive health system. Besides, no major health system dominates the region, meaning that competition is better than in other places.

“As payment for care is aligned with positive patient outcomes, the practice of care becomes more holistic and prevention-focused — which is good for the individual and for their care team,” said Kyle Armbrester, Signify Health CEO, via release.

Much of the advancement around value-based care has focused on primary care, but Aspen is a network of 500 specialists working to reduce costs and maintain quality. Signify provides analytics and support services to the providers to help them manage the treatment, predict needs, and keep costs low without sacrificing results. Signify’s technology offers support for surgical screening and diagnostic procedures in orthopedics, cardiology, gastroenterology, spine, urology, and pulmonology, as well as conditions such as asthma, low back pain, diabetes, hypertension, COPD, heart disease, arthritis, colitis, and Crohn’s Disease.

The partnership means that Aspen and Signify can manage an episode of care for 50 percent of all commercial health plan spends. This includes chronic conditions, which bundles payment for all the costs for a given chronic condition for the entire year. Signify helps identify high-quality providers, and health plans can incentivize members to choose those physicians for their care. Bundling the episode of care means that a payer such as Medicare or an employer can have a guaranteed price for a specific condition or procedure over a period of time and not have to deal with unexpected costs. Meanwhile, providers are incentivized against doing unnecessary procedures, as they would have to eat costs that exceed the bundle.

“For the majority of episodes, quality control is going to come from more aggressive care coordination that will result in avoidance of ER visits and facility visits,” says Tami Hutchison, senior director of business development at Signify. “What we need, want, and deserve is a reward for doing those things that are keeping people out of the ER and keeping people out of the hospital. Episodes of care provide the infrastructure for being able to do that.”

“We feel we’re more effective in choosing the lower-cost site of service for the right patient, at the right time, at the right place,” says Dr. Rick Snyder, cardiologist and chairman of Aspen Physician Network. “We have that to offer.”

Signify helps providers analyze their patient panels, establish a price or cost of care, look at the historical population, and risk their patients. They prefer to work with independent providers who aren’t incentivized to refer patients to a certain hospital system that may not be the highest value location. Here in DFW, Signify is marketing their product to large employers where episodes of care savings will have a significant impact.

“We feel there’s a lot of opportunity and interest on the public entity side,” Hutchison says. “We’re certainly talking with large employers, but this is the time when public entities are pressured from all sides. They have seen their inflation go up year over year, and in many instances, they have passed on as much of that as they can on to their employees, or they’ve absorbed it. And their tax revenues are down. Employers and their employees are financially crunched, and they can’t continue to add point solutions, particularly on the public entity side.”

Aspen hopes to work with primary care providers interested in providing value-based care to their patients, mapping out care pathways for patients who may start with a check-up and need a higher level of care. Working with independent physicians means that patients can undergo surgeries or other procedures at ambulatory surgery centers rather than hospitals, which are often at least twice as expensive for most surgeries. The providers also use Signify data to guide patients away from inefficient skilled nursing, long-term acute care, or rehab facilities. Much of the costs in an episode of care occur.

“We’re a unicorn,” Snyder says. “This has not been done. This is a unique model. It is innovative. There’s a lot of markets you really couldn’t do that.”