Bridging the gap between payers and healthcare providers has been a key strategy for Karl Hess, interim CEO of Arlington-based Texas Health Aetna.
Mr. Hess discussed value-based care in Texas on the "Becker's Healthcare Spine and Orthopedic Podcast."
This is an edited excerpt. Listen to the full episode here.
Question: How do you anticipate Texas Health Aetna will evolve in the value-based care environment?
Karl Hess: Sometime in the past, I've worked in taking full risk for some high-risk and high-cost populations, namely Medicare, Medicaid, CHIP and dual eligibles. Accordingly, you have to have a very robust set of population health management capabilities, but you also have to have the interoperability aspect and to be able to find and leverage as much actionable data as you possibly can to provide that care downstream. I'd say that there's a fairly unique environment here in Texas and north Texas in particular where the provider community has a lot of power through the Texas Medical Association and has been a bit slow to adopt some of the value-based care strategies and capabilities, such as risk sharing and payer-provider partnerships.
Our north Texas physicians have been fairly happy with either fee-for-service or fee-for-value over time. But that said, one of our strategies here in the local market has been to identify and work with and through partners that can help bridge some of those traditional gaps between payers and providers. … We need to find some creative means and solutions to generate that requisite alignment between payers and providers. That's not always an easy task, but it is a very worthwhile one.