Ep 60 – Cultivating Reverence Through Value-Based Payment, with Akil McClay

This is one of the most health challenging times in modern history. Healthcare systems and practitioners face dire circumstances in delivery of care to scores of citizens. A reverential ethic in healthcare leadership that promotes an informed and respectful approach towards life is key to health system success in population health. This core value is how Trinity Health, one of the largest integrated care delivery systems in the nation that serves more than 30 million people across 22 states, approaches their transition to value-based payment.  They believe the “race to value” is a moral imperative to improve community outcomes and ensure health equity, instead of just a business opportunity.

Our guest this week is Akil McClay, System Director of APM Operations at Trinity Health. Akil is responsible for the implementation, deployment and operational CIN/ACO/APM activities across four states (Delaware, Pennsylvania, Indiana and New York) with approximately 290,000 covered lives. Additionally, Akil serves as the Executive Director for the Trinity Health Integrated Care MSSP Enhanced ACO and successfully led Trinity Health Integrated Care to achieve $45M in shared savings for performance years 2017−2019. Most importantly, Akil lives the value of reverence, and his insights spark a similar passion in each of us.


Episode Bookmarks:

04:00 Akil’s formative years that led him to understand the need for minority health and health equity

05:30 How charity care hospitals impact the health of vulnerable communities

06:30 How an educational path in neurosciences led to a healthcare administrative career

07:45 “When you are a healthcare leader, you have the opportunity to impact millions of lives across the country.”

10:00 “It starts with us.  You need to have leaders that are reflective of the communities that we serve.”

10:30 Akil reflects on the presence of institutional racism in our country’s healthcare system and how Mike Slubowski is committed to DEI in leadership

11:15 Akil discusses the inequitable distribution of vaccines in the Philadelphia market and how Trinity was able to operationalize equity through a rapid-cycle innovation approach

15:35 How the VA system is an exemplar of value-based care innovation and why the private sector should learn from them as it moves to fully-capitated payment

17:40 A fully-capitated, total cost of care model gives us the best ability to care for our patients.”

18:05 How Trinity is moving to a fully-integrated EHR system across all of its markets

19:20 Engaging patients in healthcare by creating a community-based center (a lesson learned from the VA)

21:40 Akil discusses how Trinity Health has been able to navigate the COVID-19 pandemic

24:00 Trinity Health’s deployment of a unified telehealth platform

25:00 High-speed internet access as a social determinant of health

27:40 Trinity Health’s early beginnings in value-based care led by Rick Gilfillan and the aspirational goal of having 75% of revenue derived from the APM portfolio

29:00 The future of VBC is in risk-based payment and how early adoption of CMMI programs allowed for innovation

30:00 “We want to have the majority of our revenues come from value-based contracts because we believe that is what’s best for the patient.”

31:20 Do we need as many hospitals as we currently have in the United States?  What is the impact of COVID-19 on the movement to VBC?

33:00 Akil discusses how Trinity Health is building out capabilities for risk coding and documentation to better reflect burden of illness in their patient population

37:40 Trinity Health’s approach to building an integrated EHR and digital health platform for patient engagement

42:00 EHR optimization through provider-led workgroups and use of internal teams to build a homegrown analytics platform

44:35 Overcoming the limitations of digital tools by listening to patients

45:40 Streamlining provider EHR workflows at an enterprise level

48:00 The formation of Truveta, a consortium of health systems pooling patient data to glean insights into medical conditions for more personalized medicine

51:00 Trinity Health’s advocacy for value-based payment and applying lessons learned from participation in the Next Generation ACO (NGACO) Model

52:30 The importance of reinstating the application process for the CMS Direct Contracting Model (or extending participation in the NGACO Model)

54:10 Parting thoughts from Akil on how moving to VBC is “fighting against tradition” and how organizations should look to build sustainable non-FFS revenue streams

56:00 “This is hard. We have to think differently about how we get paid as we move into this value-based economy.”