Healthcare industry professionals have turned their attention to the budding Risant Health, a nonprofit founded by Kaiser Foundation Hospitals and Geisinger Health, and what it does. can mean value-based care.
On Wednesday, Oakland, California-based Kaiser and Danville, Pennsylvania-based Geisinger announced the launch of Risant, which plans to acquire health system and create a national network focused on value-based care. If approved by state and federal regulators, Risant will buy Geisinger as its first member health system.
Kaiser, a $95 billion system spread across eight states and Washington, D.C., has committed to invest up to $5 billion in Risant over five years in technology, tools and services.
“Everybody’s focused on the fact that that’s the direction of the healthcare industry, especially the reimbursement model. And so they’re trying to plan right now for what they need to do to get there. take advantage of the focus on value-based care,” said Sarah Ernst, partner at law firm Alston & Bird.
Much of the industry still operates on a fee-for-service basis, where the provider is paid for each service provided. With value-based care, providers are incentivized to provide high-quality care at a lower cost, and they are paid based on the patient’s health outcomes.
Kaiser operates a self-contained integrated care model in which its 12.6 million health plan members pay for access to coordinated services in inpatient, outpatient and outpatient facilities. other care facilities. Similar to Kaiser, Geisinger offers health plan options to patients and organizes its care model to focus more on public health and preventive care.
Risant’s strategy built on the mid-Atlantic presence Kaiser had in Maryland and Virginia. Geisinger’s 10 hospitals and 500,000-member health plan spread across central and eastern Pennsylvania complement Kaiser’s footprint.
States like Pennsylvania and Ohio are good regions to experiment with value-based care, given their well-established hospital ecosystems and health systems, said Nathan Ray, One partner in health care and life sciences at the West Monroe consulting firm. Risant will be able to build on those connections and take more risks at scale, he said.
“There’s nothing that I’m hearing here that says this nicely lit a fire that they haven’t already lit,” Ray said. “Hopefully Kaiser and Geisinger… have run some of their own value-based plays. Both continue to understand the pressures on today’s systems and are adapting to that. [Kaiser] There is always a special model. That, by itself, is often seen as a unique way of providing service.”
Primary care is often the easiest starting point for inclusion in value-based care. Its payment models are better suited to the cost of care, and primary care providers often manage a broader range of patient care. Intensive care can be more unpredictable with varying costs and sensitivities.
Ray said he sees potential opportunities for Risant and his members to expand into more medical specialties and incorporate a value-based model into those types of care.
Creating a value-based network to align supplier and payer priorities is not easy. Neal Shah, a shareholder of the law firm Polsinelli, said many systems face challenges when they get past core activities, such as changing legal structures or compensation policies.
A Kaiser spokesperson said the caretaker model of the system may not work in all geographies, apart from being slow to scale and requiring significant capital to penetrate new markets.
Shah said whether Risant’s new strategy translates to a shift towards value-based care remains to be seen.
“These are two systems that have had a lot of success in this area, but it’s not yet clear if it’s something that’s transferable,” he said. “Does this create a platform to help other types of health systems adopt similar types of integration models, or is this just something unique to the Kaiser and Geisinger cultures and organizations?” ?”
Both systems have adjusted their thinking to consider the entire continuum of care, Shah said, and they have a track record of keeping hospital usage costs relatively low.
As part of the agreement, the newly formed Risant and its members can use resources from Kaiser, but it will continue to operate as a separate organization. Having the support of a nationwide brand like Kaiser could be a windfall for health systems participating in Risant, Ray said.
Lauren Berryman contributed.
