Salt Lake City-based Intermountain is spinning off a company to focus on helping other providers hasten their movement toward pay-for-performance models. Dubbed Castell, it will be helmed by the health system's chief operating officer of community-based care, Rajesh Shrestha.
Shrestha, who came to Intermountain from Cigna, spoke to Healthcare Dive about how the spinoff can generate revenue, how it will seek to nudge providers to take on more risk and who the potential partners might be.
Here are some other thoughts he shared in a recent interview.
This interview has been edited for clarity and brevity.
HEALTHCARE DIVE: How did you first hear about this company and what was you reaction to it?
RAJESH SHRESTHA: We, collectively, at Intermountain have been on a journey toward value-based care, and we split the company basically into two businesses in late 2016 — specialty-based care focused on our acute care and keeping people well in the hospital; and community care, which is essentially keeping people well out of the hospital and in the right site of care.
And from that methodology in terms of splitting the businesses, we started honing our population health skills even more. And what we've uncovered is through our reimagined primary care work and some of our work with our affiliate partners, we decided that there is a lot of pain still for providers in the community as it relates to value-based care. And we feel like we developed a system over the course of the last several decades that we feel we can start bringing to the community to benefit providers and those patients.
Value-based care is a broad term. Can you be more specific about what Castell will do?
SHRESTHA: First and foremost, Castell has a reimagined primary care model and the results of the model are pretty significant. So we feel like we've been growing aspects of that model to help providers transition in this journey, and the difference is, this isn't just a [Medicare Advantage]-specific model like some organizations focus on. This is across all product lines where you're essentially taking some form of risk.
So that's one. Two is, Castell will have technology components to it. So there will be a large digital aspect to Castell both in helping providers at the point of care but also helping providers connect to patients in a different way — a focus on social determinants, etc. So it has a couple of mechanisms within the platform, but the main ones are care delivery, management of risk, a large technology component focused on several aspects of care and social determinants, and then it will also have opportunity to leverage Intermountain intellectual property. So we're going to digitize and productize Intermountain intellectual property in a number of care pathways and have provider partners leverage that if needed.
What's the business model for this? How do you make money?
SRESTHA: This organization wasn't stood up to be a new source of revenue. This organization was stood up to be mission-oriented and with a focus on helping providers, which, in turn, helps patients and communities.
That said, we're thinking through different aspects of how this would essentially generate income so we can reinvest back into the community. And depending on what aspect of the platform is chosen, there's probably a different revenue model. So anything from a traditional management fee to subscription fees — things of that nature that allow us to work with our partners.
Do you have any partners lined up yet or any you're targeting?
SRESTHA: Yes, we're in dialogue with a few — confidential, we can't mention who — but there's been a lot of interest, I would say, even before we launched in terms of some dialogue with our partners prior to launch and then a whole lot of interest post-launch, with health systems, provider organizations and nontraditional aspects such as technology partners that are wanting to partner and/or be clients.
How are you going to measure success?
SRESTHA: Intermountain traditionally measures success by looking at the impact we make to communities. So our success will be first and foremost focused on that. So the proxy to that will be how well we're helping patients and providers in the value-based care context — so if we're able to help more providers succeed in value-based care and help the pendulum swing faster to the value-based care, such as Intermountain has done. Intermountain's topline revenue is 40% in the risk environment. How do we help providers take on more risk and how do we help them manage that risk more effectively so they can reinvest back into their patients community?
You mentioned that it's clear there are still pain points for providers trying to make this shift to value-based care. Can you talk about what some of those pain points are?
SRESTHA: Some of the results, particularly in [accountable care organization] programs, aren't where they need to be for providers. You see a lot of health systems not entertaining government programs now. So there is some semblance that there haven't been the results necessary for providers to stay in. And we think those programs are important as you think about the transition to value-based care.
On the commercial side, as you think about providers that are taking risk, there's still opportunity. A lot of providers, the percentage of their patient panel isn't as large as you would think it would be as it relates to risk. There's still a lot of fee-for-service. Hence a lot of press on the system, and we want to be on the forefront of helping with that.
There's a lot of pain points still with patient engagement, with understanding social determinants and knowing what to do with them. And all aspects of digital — telehealth, remote monitoring — how can we help providers with that with seamless tools and platforms to address all of this.
Are you going to work with smaller practices?
SRESTHA: This will be across the board. In the markets we're currently in, we're looking to work with all sorts of providers, starting with the small independent practices and working up to medical groups and health systems if necessary.
We've been getting inquiries from all over the country asking about how this might be able to help their health system or medical group. But a big part of this is ensuring independent providers can stay independent by giving them the tools and the resources they need if that's what they so choose.
Historically, industry has been slow to make these changes. What are the broader ways you can convince those providers who are slow to accept the idea of downside risk?
SRESTHA: Rather than offer a point solution, we're offering a platform approach, which allows for assistance on multiple points. You're not just going to solve value-based care by getting the right contract or getting even the right tools in place. It is a comprehensive approach from a delivery standpoint, a technology standpoint, a social determinants standpoint — all of those things aggregated together are what's going to deliver a path forward toward success in value-based care.