Partnership for Full Potential: Sara Teppema Outlines New Rules of Engagement for Payers and Providers in Value-Based OB Care

Sara Teppema has 30 years of health care and actuarial experience. She currently focuses on design and development of population health programs and value-based payment models. Sara previously led the design of new payment models at Health Care Service Corporation; and prior to that she led the actuarial team at Valence Health (now part of Evolent Health). Wildflower recently interviewed Teppema for best practices on collaboration between payers and providers in the new era of value-based OB care.

What do you think are the most critical elements to address when moving forward in a value-based arrangement for maternity care?

First, you need a connection with mom so you have the understanding of what is keeping her from optimal care. You can’t just look at data and know why a patient didn’t answer a phone call. You need a relationship to determine that. 

Measurement is a big challenge. Value-based care requires good data, and lots of it. You’re trying to offset variability, and you’re trying to prove the value of an intervention, compared to a projection of something that didn’t happen. You can have all the methodologies, predictive models and actuarial techniques, but if you don’t have the data, it doesn’t matter.  

Partnership is also important. You need alignment from the very beginning, including guiding principles that are patient-centered. There’s often not enough trust between payers and providers. Coming at program design from a patient-centered perspective is the best way for stakeholders to align. What’s best for the patient is best for everyone. You can design the greatest program in the world, but if people don’t agree to it, it’s not worth much. 

Finally, fewer silos results in better outcomes. Payers are typically very large organizations. Sometimes, even their own internal teams don’t talk to one another. Add in providers, and you have financial, clinical, operational and support teams from multiple organizations that are all disconnected and typically not communicating effectively. 

Given that providers and payers will have to collaborate more closely in the design and implementation of value-based care, what advice do you have for both of these stakeholder groups?

For Providers 

Providers need to think like payers, which means also focusing on the patients who aren’t in the exam room already.  if you are an OB and you keep a mom healthy, get her in for necessary visits, catch risks such as gestational diabetes early and avoid complications such as a preterm birth, you should be rewarded for doing that. Extending the primary care model to other specialties such as OB has a lot of potential. These providers are the closest to the health of their patients and in the best position to keep them healthy. 

If you are provider who is bringing your own value-based care model to the table, it has to be low friction for the payer. Payers are super complicated, are generally siloed and sometimes have older systems. They aren’t going to change what they are doing for one small segment of their population. Whatever you propose has to be easy to implement, which means you have to think about what is easy for the payer to do and make your model fit that. You also need to be able to talk about the numbers and be equipped to have that conversation. We have found that if you start a conversation with a payer from a weak statistical base,  you immediately lose your credibility. Your analysis and recommendations need to be sound. If you don’t have your own data models, borrow from the literature or find an actuary to consult with your practice. 

For Payers

Payers should try to come at value-based care with a less heavy handed approach in terms of standardization versus customization. Design models that have standardized elements but still make room for customization. One size won’t fit all provider groups. It’s difficult for provider partners when the payer says, “This is our model. Take it or leave it.” Each patient population is different, and some parameters might work for some providers and not others. Some providers will be able to bear more risk than others. Payers need to be flexible.

Payers also need to be better at keeping providers up to date with data and reporting. The data needs to be delivered more quickly, but also in a way that makes it actionable and usable. And then you have to understand that some providers can’t effectively absorb data yet, so in addition to providing flat files you also need high level, basic reports on key stats and cost utilization.

Value-based care provides a new opportunity to more deeply address health equity issues across the system. Understanding that you have a lot of passion around this issue, could you share your point of view?

I’m absolutely astonished by the disparities in our country, particularly the ones we have in maternity outcomes. Rewarding providers who close gaps in racial disparities would generate extraordinary improvement in outcomes, and in savings, but I’m not seeing a lot of equity based measures included in value-based care contracts at this point. That being said, conversations around this topic are gaining momentum. When it comes to health equity, we generally don’t have good data, especially at the member level. The provider likely has some, but the payer doesn’t. It’s hard to measure performance without data. I think more payers will start to demand that providers collect data on race/ethnicity or social needs and provide that back to the plan. 

The other connection point here is making sure providers know which resources are available to patients through the health plan. Some payers are working with community service organizations to make sure their members have resources for installing car seats, connecting with other moms, childbirth classes and reducing postpartum depression. If the payer can collaborate with the provider to more effectively connect members to these resources, we would see marked improvements for moms.