At Lehigh Valley Physician Group in Allentown, Pa., 95 percent of revenue currently is generated by volume, says Michael Rossi, M.D., physician executive director for the 900-clinician group practice. Consequently, the transition to value-based care delivery and payment is not a minor shift in strategy and execution.

But the organization, part of Lehigh Valley Health System, is in the early stages of change, with community care teams supporting six practices and helping them to manage risk. The nurse care managers, social workers, practice coaches, and information technology support team members, among others, are focusing on low-hanging fruit, such as improving medication reconciliation, care follow-up appointments and care management, at an annualized cost of about $1 million.

Patient demographics dramatically tell the story of why Lehigh Valley is working to improving outcomes while reducing costs, Rossi explained to a health insurance audience during AHIP 2013 in Las Vegas. Ten percent of the patient population has advanced illnesses or multiple chronic conditions, accounting for 52 percent of costs.

So providers obviously need help making the transition and there are basic ways for payers to support them, Rossi said. For instance, to facilitate team-based care, clinicians should be working at the top level of their license so they need payer consistency in credentialing. Insurers also can support development of a provider-based infrastructure through shared savings and coordinated care management with less duplication of services.

Other requests for support on his payer wish list include better bi-directional flow of information with insurers to marry claims and clinical data for analysis, standardized quality metrics and incentives across all payers, provider compensation that rewards value and productivity, and help with engaging providers with education, a common vision, a performance data infrastructure and incentives for those resistant to change.

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