Left,  Aaron Rust, executive director of Providence Medical Group and Chris Pizzi, chief executive of the Southern Oregon Service Area for Providence Health & Services.

左图为普罗维登斯医疗集团执行董事亚伦·鲁斯特（AaronRust）和普罗维登斯健康与服务（Providence Health&Services）俄勒冈州南部服务区首席执行官克里斯·皮齐（ChrisPizzi）。

Photos: Courtesy of Providence Health & Services

照片：由普罗维登斯健康与服务公司提供

Value-based care has long been the goal, but becomes more than aspirational when the majority of patients are paying through Medicare and Medicaid.

长期以来，基于价值的护理一直是目标，但当大多数患者通过医疗保险和医疗补助支付时，它变得更加令人向往。

Providence Health & Services in Medford, Oregon has a payer mix of 60% Medicare and 20% Medicaid, according to Chris Pizzi, chief executive of the Southern Oregon Service Area.

俄勒冈州南部服务区首席执行官克里斯·皮齐（ChrisPizzi）表示，俄勒冈州梅德福德（Medford）的普罗维登斯健康与服务（Providence Health&Services）拥有60%的医疗保险（Medicare）和20%的医疗补助（Medicaid）的付款人组合。

This means 80% of Providence Medford Medical Center's reimbursement is based on fee-for-service Medicare, Medicare Advantage and Medicaid. All pay less than the more lucrative commercial-based health insurance.

这意味着普罗维登斯·梅德福德医疗中心80%的报销是基于按服务收费的医疗保险、医疗保险优势和医疗补助。所有这些都比利润更丰厚的商业医疗保险要低。

This is when risk-based contracts become a financial lifeline, Pizzi said.

皮齐说，这是基于风险的合同成为金融生命线的时候。

'The payers mix in southern Oregon is challenging,' Pizzi said.

皮齐说，俄勒冈州南部的付款人组合具有挑战性。

The southern Oregon service area is about the size of Connecticut and has an estimated half a million people. The city of Medford is the most populated, with people coming in from more rural areas in Jackson County.

俄勒冈州南部服务区的面积约为康涅狄格州的大小，估计有50万人口。梅德福德市是人口最多的城市，人口来自杰克逊县更多的农村地区。

Other than the payer mix, financial challenges include the much maligned 2.9% rate increase for Medicare in the Inpatient Prospective Payment System  for 2025 and inflation rising faster than what Medicare is paying.

除了付款人组合之外，财务挑战还包括2025年住院患者预期支付系统中备受诟病的医疗保险利率提高2.9%，通货膨胀上升速度快于医疗保险支付速度。

'The government doesn't raise their rates that high … inflation is tracking at 9%,' Pizzi said.

皮齐说，政府没有把利率提高到那么高……通货膨胀率一直在9%左右。

He and his team looked at what they could do to make hospital finances sustainable.

他和他的团队研究了如何使医院财务可持续。

Competition was also a factor, with the Asante health system just three miles away.

竞争也是一个因素，距离Asante医疗系统只有三英里远。

'We made an intentional decision,' Pizzi said, 'let's work with our medical group.'

“我们做出了一个有意的决定，”皮齐说，“让我们与我们的医疗团队合作。”

They turned to risk-based contracts and set high targets for coordinated care between acute care and ambulatory care through its medical group.

他们转向基于风险的合同，并通过其医疗集团为急性护理和门诊护理之间的协调护理设定了高目标。

'It's been given some aggressive targets to hit,' said Aaron Rust, executive director of Providence Medical Group.

普罗维登斯医疗集团（Providence Medical Group）执行董事艾伦·鲁斯特（AaronRust）说，已经给了一些积极的目标。

WHY THIS MATTERS

为什么这很重要

Many of Providence's risk-based contracts, and the largest, are through the Medicare Shared Savings Program.

普罗维登斯的许多基于风险的合同，以及最大的合同，都是通过医疗保险共享储蓄计划达成的。

The highest risk option available in MSSP allows accountable care organizations to share in 75% of shared savings or losses, according to the National Association of ACOs.

据美国ACOs协会称，MSSP中风险最高的选项允许责任护理组织分享75%的共享储蓄或损失。

Providence Medical Group is a multispecialty group of 1,200-plus caregivers and more than 500 providers.

普罗维登斯医疗集团是一个由1200多名护理人员和500多名提供者组成的多专业集团。

Value-based care dollars represent 20-25% of the total revenue for the primary care medical group, Rust said. It now represents a third of operating revenue.

Rust说，基于价值的护理费用占初级保健医疗集团总收入的20%至25%。它现在占营业收入的三分之一。

'We've grown the value-based care pie,' he said. 'It's been a critical component for us and a component to improve the financial picture.'

他说，我们已经扩大了基于价值的护理馅饼这是我们的一个关键组成部分，也是改善财务状况的一个组成部分。”

Headwinds included watching payers ratchet up thresholds and requirements to tap into value-based care dollars.

。

The provider took a financial hit when it participated in the Primary Care Plus model from the Centers for Medicare and Medicaid Services. Patient experience was a hurdle, at a time when primary care access is a challenge throughout the country, Rust said.

该提供者在参加医疗保险和医疗补助服务中心的初级保健+模式时遭受了财务打击。Rust说，在全国范围内初级保健服务面临挑战的时候，患者体验是一个障碍。

The work to overcome these challenges focused on optimizing higher margins in perioperative services and improving caregiver engagement and patient progression. All helped to reduce cost.

克服这些挑战的工作重点是优化围手术期服务的更高利润率，改善护理人员的参与度和患者进展。所有这些都有助于降低成本。

Rust said his team does a lot of outreach whenever a patient is discharged. Under this transition care management, a patient sees a primary care physician within 14 days of discharge.

Rust说，每当病人出院时，他的团队都会进行大量的外展活动。在这种过渡护理管理下，患者在出院后14天内会去看初级保健医生。

'When we connect patients with a care management team, we are actually able to reduce readmission rates,' Rust said.

Rust说：“当我们将患者与护理管理团队联系起来时，我们实际上能够降低再入院率。”。

In comparisons between patients who get the transition care management support to those that don't, Rust found almost a 50% reduction in readmission rates.

在获得过渡期护理管理支持的患者与未获得过渡期护理管理支持的患者之间的比较中，Rust发现再入院率几乎降低了50%。

'From a financial standpoint, it's a huge cost savings,' Rust said.

Rust说，从财务角度来看，这是一笔巨大的成本节约。

Quality metrics are translated to the team 'in a way that resonates,' Rust said. For instance, screenings for colorectal cancer, breast cancer and hypertension are quantified into the number of preventable deaths.

Rust说，质量指标“以一种共鸣的方式”转化为团队。例如，结直肠癌、乳腺癌和高血压的筛查被量化为可预防的死亡人数。

Margins have improved significantly since a low point in 2021, according to Pizzi.

皮齐（Pizzi）表示，自2021年的低点以来，利润率大幅提高。

Pizzi and Rust recommend having a clear understanding of payer contracts to see where risk can be tried. Robust data is critical.

Pizzi和Rust建议对付款人合同有一个清晰的了解，看看哪里可以尝试风险。可靠的数据至关重要。

Also, there should be a strong partnership between hospitals and medical groups. Physician leadership is critical to drive culture change and buy-in. Financial incentives must align with physician interest. From there, work and operational changes will follow,  they said.

此外，医院和医疗集团之间应该建立强有力的伙伴关系。医师领导力对于推动文化变革和认同至关重要。财务激励必须与医师利益相一致。他们表示，从那时起，工作和运营将随之发生变化。

THE LARGER TREND

更大的趋势

Providence Health & Services in Oregon is part of Providence St. Joseph Health, which was formed in 2016 when Providence Health & Services merged with St. Joseph Health.

俄勒冈州的普罗维登斯健康与服务公司是普罗维登斯圣约瑟夫健康公司的一部分，该公司成立于2016年，当时普罗维登斯健康与服务公司与圣约瑟夫健康公司合并。

Providence St. Joseph operates more than 50 hospitals and 800 clinics in seven states: Alaska, California, Montana, New Mexico, Oregon, Texas and Washington.

普罗维登斯圣约瑟夫在阿拉斯加州、蒙大拿州、新墨西哥州、俄勒冈州、德克萨斯州和华盛顿州七个州拥有50多家医院和800多家诊所。

Providence is the third-largest Catholic, not-for-profit health system in the United States, with a mission to serve everyone, especially those who are poor and vulnerable, according to Pizzi.

Pizzi表示，普罗维登斯是美国第三大天主教非营利性医疗体系，其使命是为所有人服务，尤其是为穷人和弱势群体服务。

The Centers for Medicare and Medicaid Services has the goal of having all Medicare fee-for-service beneficiaries and the majority of Medicaid beneficiaries in an accountable care relationship within six years.

医疗保险和医疗补助服务中心的目标是在六年内使所有医疗保险按服务收费受益人和大多数医疗补助受益人建立负责任的护理关系。

Email the writer: SMorse@himss.org

给作者发电子邮件：SMorse@himss.org