Oct 25, 2023
Our CEO, Jean Drouin, MD, recently sat down with Divya Paliwal, MD, MHA, Chief Clinical Transformation Officer at Horizon Healthcare Services to talk about achieving impact in value-based care partnerships. Watch the fireside chat here.
Jean Drouin, MD: Just to begin, do you want to tell us a little bit about the role of chief clinical transformation officer? Why and ultimately, what are you trying to achieve?
Divya Paliwal, MD, MHA: Sure. First of all, happy to be here and thanks for having me, Jean. In my role as a chief clinical transformation officer, I oversee all of the healthcare value transformation work that we do. What that means, quite simply, is as a single state health plan based in New Jersey, the work that we do with our provider partners is truly our differentiator.
Jean Drouin, MD: Can you give us an example of a model or a program that your team has been working on and that is beginning to scale?
Divya Paliwal, MD, MHA: Yeah. I can think about several examples of that, but one that comes to mind right now is about six years ago, we launched what we call our strategic alliance partnerships, also known as Omni Alliance. It’s essentially strategic alliance agreements. They’re not JVs. They are virtual agreements with seven of the biggest healthcare organizations across the state. We said let’s come together to develop a virtually integrated delivery network that is focused on the triple, quadrupling goals, looking at financial alignment, looking at care transformation, looking at technology innovation. I’m happy to say that we have had traction, which is why we are now in our renewal phase with those alliance partners.
Divya Paliwal, MD, MHA: About four years ago, we launched a pilot for social determinants called Neighbors in Health. That very successful pilot that led us to scale that pilot across multiple provider partners and now what we are saying is how do we bring that model furthermore integrated with our core value based models? Not just from a financial standpoint because remember, I mean, we need to think about these programs from a sustainability, long term success and sustainability, which is why they cannot sit in their own silos. They need to all build bridges and come together.
Jean Drouin, MD: What are some of the challenges that you faced in getting either clinicians or members to change their behavior?
Divya Paliwal, MD, MHA: The challenges truly shifting the mindset from a fee for service to value based, does not happen overnight and it requires continuing iterations. So I think that’s one. Second, how do we move the care transformation programs, clinical programs from pilots to scale? And then third, how do we provide the right kind of data insights to the providers that they can trust that they know is credible? And that’s part of the work that we have done, for example, with Clarify, which we are bringing on and saying, these are deep clinical insights. Let’s look through those and let’s engage on real opportunities.
Jean Drouin, MD: Great. And perfect segue. How is it that you have used analytics in order to help accelerate the willingness to change?
Divya Paliwal, MD, MHA: Yeah, so let me actually give you one example that really speaks to that. My team was having a conversation with one of the health system leaders, and this is one of the health systems that is really mature. Extremely tight integration on the clinical side. They have a pulse of their system and their physician partners inside out. And so we brought in the insights and they were skeptical at first, but through clicking into the deep opportunities, we were able to use your platform and look at an opportunity where there was this one primary care physician with 400 panels and 400 membership size as the panel. And almost half of it was using ED for preventable conditions. And so right there, we were able to point out, here is your opportunity and by the way, there can be other opportunities like that and we were able engage them.
Jean Drouin, MD: Where are you most excited to go from here in terms of the value-based care journey that you’re leading?
Divya Paliwal, MD, MHA: Yeah. I mean, we’ve been on this journey for such a long time, but in some ways we are just beginning. There’s so much to do. One of the key strategic priorities that we have committed to our board is the migration of the value-based to upside-down risk-based models. So that is quite clearly a focus of ours and we have multiple levels that we are using and with our partners to help accelerate, not just the health systems, but also robust independent provider group that we have in the community.
Divya Paliwal, MD, MHA: Clinical transformation. We have a lot of work that’s going on in behavioral health, in social determinants. We are evolving our medical management, what it looks like with an aligned model. So that is of interest. How can we reduce the friction points, like prior authorizations, et cetera, but in a responsible manner.
Jean Drouin, MD: How can you use the kind of insights provided by Clarify in order to drive real change on the ground, as opposed to just an insight as an insight?
Divya Paliwal, MD, MHA: That’s a great question and I think there are multiple ways in which we are doing that. Internally, the way we are doing that is making sure that the financial or the operational side of the house is really speaking closely with the clinical side. So when they are having conversations with the provider partners, both sides of the table, they come together and have conversations around how do we effectuate clinical change? What are the specific opportunities? So there is this data insight, but what does that tell?
Divya Paliwal, MD, MHA: So back to my example, if there are a lot of preventable ED visits, is it because the primary care physician was off for some time and did not make the members move to another colleague of theirs? Or do they have an access problem? So it’s figuring out what the root cause is, and then solving for that. And then finally, I think from a provider perspective, making it self-service so that they can really use those platforms, they know how to use the platforms and dig into that. So teaching them how to fish themselves has been one of the areas of focus for us as well.