Privia CEO on Value-Based Care, ACOs, & CMS

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Editor’s note: Shawn Morris retired as CEO on June 30, 2023, but remains on the company’s Board of Directors.

This blog post is adapted from a discussion with Privia Health CEO Shawn Morris for The Break Room podcast and has been edited for length and clarity.

“Given the immense complexity and constant change within healthcare, it’s impossible to fully and neatly summarize the industry,” Privia Health CEO Shawn Morris noted in an op-ed.

Distilling all of healthcare’s trends, obstacles, and solutions into a single article is indeed unfeasible. However, examining the micro and macro forces at play is still a worthy endeavor as it reveals opportunities for improvement. As Morris concluded: “We must pursue operational excellence by continually questioning our assumptions and refining our solutions.”

As we near the end of the first quarter of 2023, we had an opportunity to sit down and hear his perspective on today’s most urgent issues, emerging trends, etc. You can listen to our full conversation to hear illuminating insights on topics, such as:

  • Initiatives to advance health equity and improve care access
  • Solutions for health systems’ shrinking margins and patient volume
  • Partnership options for fiercely independent physicians
  • Elevating clinical voices through physician-led governance
  • Refining Medicare Advantage amid record-breaking rates of enrollment
  • Driving the Quadruple Aim’s goals of improving affordability, population health, patient satisfaction, and provider well-being

If you enjoy this sneak peek, be sure to listen to the full episode.

The Break Room: Every year, value-based care makes progress while also running into obstacles — some new, some old. What is your outlook on the state of value-based care in 2023, and what might independent physicians and health systems see?

The Centers for Medicare and Medicaid Services (CMS) is leading the charge in value-based care, which, 10 years ago, you would’ve never heard me say. Medicare Advantage has existed under three different names for 30 years, and the Medicare Shared Savings Program (MSSP) came into play about a decade ago. CMS continues to get a lot of programs out there. This administration has whittled them down, but they’re really big on the MSSP as it’s one of the few that has worked and saved taxpayers’ money. They’ll continue to refine Medicare Advantage; it’s a program that the consumers and seniors love.

So, from a value-based care perspective, CMS is definitely leading the charge. We get very relevant, good, and timely information on beneficiaries through CMS. And we have the top savings rate of any accountable care organization (ACO) in the country of over 40,000 lives. We’re very proud of that. Our physicians work diligently with their care teams — and us alongside them — to make that happen.

Discover how a Privia partnership can help doctors get started, thrive, and profit in value-based care.

CMS has come out and said, “We’re going to have every Medicare beneficiary in a value-based care plan by the year 2030.” That has not changed from one administration to the next. We probably couldn’t have had two administrations that think differently about almost everything, but that is one policy that’s consistent. There are more seniors becoming Medicare eligible every day, and there have been for a few years now. That leads to about 50 percent of the patients out there being enrolled in a government program, so you have to take note.

That happens through organizations such as ours that are working very closely with payers and in an aligned relationship. In just the past couple of years, it’s been remarkable. The relationships we’ve built with certain non-government payers are uniquely different. We’re always going to debate. We’re always going to have disagreements. But, generally speaking, we’re all aligned. Our results show that we’re lowering the total cost of care while improving quality. As a payer of healthcare, that’s what you’re looking for.

Explore one industry expert’s perspective on the intersection of value-based care and the Quadruple Aim.

So, I think the heavy influence of CMS will continue. As I always say, it’s never at the pace we all want it to be, but we have to keep chugging along and making a difference. I believe companies like Privia, inspired doctors and physician leaders, and forward-leaning health systems know that value-based care is the future. And that, in the next five years or decade, we’ve all got a lot of work to do to keep that rolling. That means instilling some of these principles, aligning incentives, changing payment comps, and having physician organizations with the governance models and the technology to do the job.

All of that needs to start coming together. None of that happens overnight. It gets down to everybody believing in the mission, finding the right alignment between all of the parties involved, and then — when you have differences — working through them.

At the end of the day, our goal is to improve the well-being of our partners; and the benefactors of that will be the patients.

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