Henry Ford Health System is an integrated health care system that has included hospital and medical group components in a tightly aligned structure for over 100 years, and health plan, long-term care, and other components for 30 or more years. Henry Ford Health System is firmly committed to expanded participation in a variety of forms of Alternative Payment Models. There is a strong historic base already for participation in “alternative payment models”, with the Henry Ford Medical Group having provided care for Health Alliance Plan members (the System-affiliated health plan) under a full-risk capitation agreement for over 25 years.
We have recently begun participation in the CMS Next Generation ACO program (category 3B in the HCP LAN APM Framework), and have applied for participation in the CMMI Oncology Care Model demonstration (category 3A in the Framework) in both the provider and plan roles. We participate in a variety of value-based contracts with Blue Cross Blue Shield of Michigan, and have begun to develop agreements for tertiary and quaternary service provision with other local and regional ACOs. Most of these arrangements would be classified as category 2C, since they involve tangible financial rewards for actual performance on defined quality metrics. We have recently joined the Federation Care Network, a collaboration of integrated health systems in Michigan that has been created to enter into value-based contracts with public and private payers.
The full-risk capitation arrangement that existed for many years between the Henry Ford Medical Group and Health Alliance Plan would exemplify a category 4B model. The agreement has been modified recently to move to a form of shared risk between plan and medical group, but the financial risk still retained by the medical group (approximately one-third of total) represents a significant risk for a defined population held by a provider entity, and would also exemplify a category 4B agreement.
The recently-completed “Strategic Path” for HFHS includes a strong commitment to growth of involvement in APMs, under three specific strategic programs:
(1) “Integrated Care and Coverage”, involving individuals who are both members of the HFHS-affiliated health plan (Health Alliance Plan) and patients in the HFHS delivery system at the same time;
(2) “Value-Based Care”, involving individuals who are patients in the HFHS delivery system but insured through a different private or public entity; and
(3) “Complex Tertiary Care” involving patients who come to HFHS for high-end specialty, inpatient, or procedural services, perhaps through bundled payment arrangements with a variety of payers.
We have declared a goal of expanding the pool of individuals in the “Integrated Care and Coverage” category from approximately 125,000 to 500,000 over the next 5-10 years. An expansion of this size would mean that “ICC” would expand from approximately 20% of overall system revenue to 50%. Progress toward that goal will be measured every year. We also expect that revenue in other domains (e.g., tertiary care) will also come increasingly through value-based contracts, but we do not have specific quantitative goals or timelines in those areas.