When it comes to healthcare, excellence, and accessibility are essential to both the provider and the payer.

In this interview, SourcEdge CEO Mark McAdoo gains insight from Lili Brillstein, Founder and CEO of BCollaborative. They discuss Brillstein’s journey from public health into value-based health care. Brillstein has worked both on the provider and payer sides and brings a public health perspective to all of the work. She is passionate about building partnerships between payers, providers, and other stakeholders that focus on improving patient outcomes and experiences and managing overall care costs.

Topics covered in the interview include:
· The current state of value-based care in today’s healthcare climate
· Understanding both payer and provider expectations
· Advice to position solutions with payer and provider decision-makers

Most providers and their partners have difficulties understanding how to work with payers. Physicians and other care partners want to build care models that are clinically meaningful, and they perceive that payers only want models that cut costs.

Payers, on the other hand, may believe that providers are out to game them—providing unnecessary services just to get additional payment—since the fee-for-service payment methodology prioritizes volume over value. The more services one provides, the more income is earned, as payment is made regardless of the impact on individual patients’ health.

Neither of these perspectives is entirely accurate. Providers and payers, together, are responsible for the management of care and the cost of care of their individual patients/members.

In 2020, a group of stakeholders met to discuss how to build a comprehensive value-based framework for chronic conditions (ie, a model that prioritizes a holistic view of the patient, promotes communication among all those caring for the patient, and proactively confronts common barriers in the way of best practice protocols). As a case example, the Group chose to examine psoriatic arthritis (PsA) and determine potential solutions. The Group of 20 members, comprised of a payer, physicians of multiple specialties, a pharmaceutical manufacturer, a value-based care architect, and an analytics organization met three times virtually throughout 2020. The Group steering committee met biweekly throughout the year to review data, models, and discuss the input from the larger team. The Group’s goals were (1) to gather the full spectrum of stakeholders to address variations in care and cost of care for patients with PsA; (2) explore the current and prospective roles of each stakeholder; and (3) ultimately build a value-based model to optimize care for PsA. The Group determined several key challenges to delivering care to patients with PsA. They also highlighted several points that should be considered when building a value-based care model for this patient group. Quality goals are under review by the Group steering committee, and the clinical and operational assessment is underway to prepare for year 2. The project is an exercise in how to bring together diverse, historically adversarial partners to leverage the expertise of each to build something together that is focused on their collective patients/members.

A Novel Digital Classification System Identifies Variances in Cancer Care Cost to Support Value Based Care Delivery

Value-based care is not one size fits all — different diagnoses may require different approaches to achieve the Triple Aim. And every approach requires a partnership between clinicians and payers. On the latest episode of The Scope with Dr. K, Brillstein and Kosinski talk about payers and clinicians working together, the similarities and differences in procedural and disease-based care bundles, how chronic conditions like Crohn’s and Ulcerative Colitis can fit in a fee-for-value world, and more. “What helps makes models successful is a respectful partnership,” Lili Brillstein told Dr. Lawrence Kosinski, founder and CMO of SonarMD, on his podcast The Scope with Dr. K, which airs on Healthcare NOW Radio. “We’re accustomed to contracting with our dukes up and fighting; this requires everyone takes their fists down.” Brillstein has experience forging those partnerships and creating new value-based care models to ensure all types of diagnoses fit. Currently CEO of BCollaborative, Brillstein spent years working at health plans, pioneering new value-based care partnerships.

“In 2020, a group of stakeholders (the Group) met to discuss how to build a comprehensive value-based framework for chronic conditions, ie, a model that prioritizes a holistic view of the patient, promotes communication among all those caring for the patient, and proactively confronts common barriers in the way of best practice protocols. The project is an exercise in how to bring diverse, historically adversarial partners leveraging the expertise of all to build something together that is focused on their collective patients/members.”

Due to the public health emergency declared in response to the pandemic and a myriad other reasons, the need for increased access and coverage of behavioral health services is necessary to meet a growing demand. World Congress is pleased to host another webinar series to continue these important conversations around mental health and wellness, Substance Use Disorder (SUD), and telebehavioral health care delivery. Join you peers from across the health care ecosystem focused on BH – health plans, providers, government, community organizations, and others – during this webinar series to hear approaches and best practices being developed and implemented to integrate behavioral health, adopt value-based care models, use technology to deliver MH and SUD screenings and services, and more.

Health plans have been striking more and more risk-sharing agreements with providers and digital health companies as the shift to value-based care intensifies—but that momentum faces challenges, analysts say.

Lili talks about some of the major drawbacks of the fee for service model, “There is this sort of perverse incentive around quantity rather than quality, for patient outcomes, which often results in fragmented and or unnecessary care for individuals and results in really, less than optimal outcomes. As we’ve seen medicine continue to evolve and people are living longer and with more complex diagnoses and co-morbidities the fragmented fee for service model really does not work effectively to support these patients and individuals with these situations and certainly not to produce optimal outcomes or a thoughtful use of limited resources.”

Lili mentions “And so one of the things I always say to providers and startups and tech vendors who are going in to talk to payers is you need to be thoughtful about what they can actually do and not do. And to listen to what they’re telling you because they may not be saying no because they don’t like your idea. They may be saying no because administratively it’s difficult.”

Managed Healthcare Executive’s Senior Editor, Peter Wehrwein, and Associate Editor, Briana Contreras, spoke with MHE Editorial Advisory Board Member Lili Brillstein for a new episode of the “Meet the Board” series on “Tuning In to the C-Suite” podcast. Lili is CEO of BCollaborative, which works with stakeholders across the healthcare continuum to successfully make the move from fee for service to value-based healthcare. In this episode we get to learn a bit more about Lili’s career and hear her thoughts on the advancements of episodes of care, as well as the challenges of transitioning from fee-for-service to value-based care during COVID-19.

Listen in as Dr. K brings patients, providers and payers together to reimagine GI care in America. He and his guests will discuss emerging trends, research, care and payment models, technologies, regulatory pressures, policies and more. It’s time for a gut check on how GI can help meet the quadruple aim in healthcare: an improved patient experience, better health of the overall population, lower costs and happier providers.

Dr. Rosenberg and Lili discuss her experience working collaboratively with GI practices in New Jersey and what the future holds for value-based care models in specialty medicine.

I am so delighted to say that I’m working with payers and providers and Pharma and a number of startup companies really with all of them to craft their strategy around value based model design and engagement.

The shift from fee-for-service to value-based care requires collaboration, communication, and coordination across the care continuum, said Lili Brillstein, CEO of Brillstein Collaborative Consulting, and former Director for Episodes of Care at Horizon Blue Cross Blue Shield of New Jersey.

Unlike in fee-for-service, we have an amazing opportunity to begin to understand and build in factors that will keep patients healthy and give them the best outcomes possible, said Lili Brillstein, CEO of Brillstein Collaborative Consulting, and former Director for Episodes of Care at Horizon Blue Cross Blue Shield of New Jersey.

New technologies and quick drug approvals contribute to the challenges of incorporating value-based care in oncology, said Lili Brillstein, CEO of Brillstein Collaborative Consulting, and former Director for Episodes of Care at Horizon Blue Cross Blue Shield of New Jersey.

Lili Brillstein, M.P.H., Director Episodes of Care, Horizon Blue Cross Blue Shield of New Jersey, explains how an episode of care is different from a bundled payment.

Expert panel discussion sponsored by Change HealthCare.

Through ‘Episodes of Care’ model, doctors ensure more convenient, less costly care with better results.

Predictable, seamless oncology care begins with an effective value-based reimbursement model. Cancer is among the most frightening diagnoses for patients to receive.

How will the pandemic impact the adoption of value-based care?

Chronic diseases represent a growing burden of morbidity, mortality, and cost worldwide.

Transitioning to value based care requires that healthcare system participants rethink how to deliver and compensate for healthcare.

Oncology diagnoses are among the most complicated to bring into value-based care for many reasons

The technological revolution that has reshaped industries as varied as banking, entertainment, and transportation has now reached an industry long thought immune to such disruptive innovation–healthcare

The episodes of care payment model is designed to
put the patient at the center of care delivery with
their care coordinated among all providers for more
comprehensive care to achieve the best possible outcomes.

COMMENTARY ABOUT THE EPISODES OF CARE MODEL

PRACTICE MANAGEMENT: THE ROAD AHEAD

Engaging Payers