Abstract
We live in the most dynamic time in the history of the healthcare industry. There is more discussion in today’s healthcare world about innovation, disruption, care delivery, value, quality, workforce, and finances than ever before. The question that begets, however, is that are we better for those discussions today than we were yesterday. Certainly, as we contemplate newer strategic and operating models to help drive these discussions, a requisite view of some of the fundamental components of healthcare needs to sharpen in focus, perhaps most notably the newer evolution to the “Quintuple Aim 1 ” and the business activities intended to drive the Aim’s enablement.
This “Quintuple” focus adds to the original “Triple Aim” of improved patient experience, better outcomes, and lower costs, furthered with the “Quadruple Aim” adding clinician well-being to the mix. Now, we have an appropriate evolution to add health equity to the mix to consider social drivers/determinants of health in the calculus. As the Aim has evolved with a more well-rounded north star for the industry, we have likewise seen the evolution of transactions and partnerships in the industry to support our approach to achieving the matured Aim. One such relationship is the emergence of the “Academic Payvider,” around which the underlying article, “The Academic Payvider Model: Care and Coverage” illuminates several distinctive perspectives. The commentary herein builds on those perspectives, further validating this newer relationship as one worthy of evaluation.
With all the surrounding complexity, it has never been more critical to narrow down the complicated elements in our industry to those few most salient points impacting our hoped-for future. Therefore, this commentary posits three elements worth considering as the Academic Payvider comes more into view—the maturity of these collaborative relationships, the characteristics required to execute them, and the promise they bring to the communities served. Tomorrow’s healthcare industry could benefit more from an understanding of all three, and, as the underlying article points out, several organizations (25) represent case studies from which others can learn.
Collaboration Maturity
As the evolution of Academic Payviders continues, while other organizations contemplate a similar level of engagement, an understanding of the value of this type of business model is worthwhile. As the underlying article points out, these organizations are endeavoring to change the local/regional landscape in the face of staggering macro and micro healthcare trends, whether through a de novo build or collaboration.
Collaborative health plan relationships are an interesting exploration for an academic institution, which merits thoughtful consideration given the expanse of tertiary and quaternary capabilities and associated higher care and facility costs to be leveraged. To achieve the utmost success, these collaborative relationships must move beyond a requisite level of transparent data sharing to capitalize on programmatic interventions across diverse populations. Once accomplished, products and services may ultimately be jointly developed in a capital-infused relationship to share investment. The most successful of these relationships brings capitated risk into the equation as an overarching objective, enabling a more value-based structure, as noted in the underlying article.
Relationship Characteristics
We live increasingly in a healthcare world, where doing more with less is an appropriate business evaluation lever. Considering how historically flawed our payment and reimbursement structures are, healthcare entities are regularly contemplating relationships with other like-minded or similarly situated organizations. The academic healthcare community has not been immune to this, including the recent merger of the longstanding Association of American Medical Colleges (AAMC) and Association of Academic Health Centers (AAHC). 2 Furthermore, the underlying article diligently points out the number of academic healthcare institutions joining hands with health plans/payers, albeit a small number relative to the overall quantity of academics.
That said, this relationship progression demands at least a cursory understanding of the characteristics necessary to support their communities more effectively. At the outset, there needs to be a mutual embrace for scalability across complementary capabilities. Both organizations should work toward a common goal of near-term success and longer-term sustainability. There’s an inherent flexibility requisite to bridge such disparate organizations, competencies, and infrastructures, particularly in the face of changing market dynamics and competitive forces. Growth targets and population demographics play significant roles in aligning product, contracting, and services portfolios. Lastly, a willingness to manage internal risk with innovative value-based risk arrangements can create a mutually beneficial risk profile for the relationship.
Execution Promise
As mentioned previously, to achieve the promise of the Quintuple Aim, we must balance the historical attributes of the Triple Aim with the well-being of the clinicians delivering and coordinating care, as well as the diverse, underserved populations deserving of equitable treatment and support options. Academic institutions across the country are pivotal in addressing critical social drivers that promote barriers to health for millions of people. 3 Food insecurity, transportation, housing instability, student health, and engagement outreach are all examples of initiatives within which academic institutions play important roles in the care and well-being of their communities. 3 A recent symposium hosted by the Harvard Medical School Center for Primary Care, including a distinctive cross-section of healthcare and industry leaders, described the lack of consistent resources and infrastructure to sustain effective community solutions, while also noting the import of multi-stakeholder collaboration to support the health and well-being of our communities. 4 Academic institutions represent significant altruistic, research-heavy agendas, but are often anchored in traditional fee-for-service delivery constructs in their healthcare enterprises, as discussed in the underlying article; whereas, the health plans/payers stand closer to the payment mechanisms that could more adeptly enable change in facilitating care for broader swaths of populations. The opportunity to mutually learn and benefit from the vast resources of both organizations as partners could operate as a natural extension of the mission and vision these stalwart institutions endeavor to achieve, so long as they each remain focused on the promise they bring to the communities they serve.
Whether the Academic Payvider is the or an answer to an industry fraught with challenges remains to be seen. The underlying article notes the sample size is still relatively small in comparison with the number of academic institutions serving healthcare overall. Nevertheless, these relationships bring inspiration for the art of what is possible to drive complex, higher-cost care down through innovative payment and reimbursement structures more effectively and efficiently managed with the expertise of such unique collaborators. If healthcare is to remain local, as many argue that it should, then we need locally oriented, deeply expert, financially enabled advanced institutions delivering care for those that need it most, when they need it, how they need it, where they need it, and with partners and business models that support it. This is no longer just an academic exercise; it is one for us all.
Footnotes
Author Disclosure Statement
No competing financial interests exist.
Funding Information
No funding was received for this article.