Think about your last doctor’s appointment. Odds are that you went to the clinic, met with your physician, and were then charged for your visit. Like millions across the United States, you just participated in what’s known as fee-for-service, a payment model where doctors and health care providers are paid in exchange for services rendered.
It sounds simple, but it is a reimbursement methodology that can be dangerously cyclical, warns Tyler Wilson ’07 ’09, the National Director of Clinically Integrated Network Development & Integrity at Catholic Health Initiatives (CHI). The fee-for-service model incentivizes providers to hold more appointments or conduct more tests, thus receiving more revenue in return. At CHI, Wilson advocates for a value-based system supported through Clinically Integrated Networks, or CINs. CHI is moving toward a capitation model, where each of their CINs is paid a fixed fee per member, per month to provide all health services during a defined period for a population.
“The incentive for health systems should be to keep you healthy and out of the hospital,” Wilson says. “CHI’s population health work pursues the Triple Aim plus one, which is to reduce per capita costs, improve patients’ experience of care, to improve providers’ experience, and to improve the quality of care.”
Based in Englewood, Colo., Wilson directs the operational elements of CHI’s 12 CINs, ensuring that each market has the necessary providers and facilities to provide meaningful access across the entire continuum of care. Instead of a reactive style of care, supported by the fee-for-service model, Wilson works to establish the required network development for a preventative style of care. CHI currently serves 19 states with more than 100 hospitals.
With the passage of the Affordable Care Act and Medicare Access and CHIP Reauthorization Act, Wilson believes, now more than ever, that the health care industry is being driven toward value-based care. He says that for-profit organizations, principally interested in delivering value for shareholders, will soon be left behind if they don’t begin to accept risk for patient populations and deliver value.
“This is an inevitable tide of change in the industry,” Wilson says. “Organizations that will be successful in the future are those able to develop capabilities to manage populations and achieve that Triple Aim plus one goal.”
An economics major, Wilson recalls the mentorship of retired economics professor Rich Butler, who told him daily that “incentives matter.” Wilson believes this idea is especially true to health care, where he thinks about how to put incentives into place to induce a certain type of behavior. With CHI, Wilson advocates for a future where doctors and health care providers are more incentivized to make patients healthier, rather than filling hospital beds or treating the maximum number of patients.
Wilson decided to enroll in Trinity’s masters of health care administration because he was intrigued by the strategy and business development aspect of population health operations. He is motivated by keeping patients out of the hospital and has, over the course of his career, worked to align his job responsibilities with the issues for which he is most passionate. Apart from an administrative residency and fellowship with INTEGRIS Health, Wilson has worked with CHI since Aug. 2010. He attributes his rapid career rise to forming quality relationships with colleagues and moving projects deliberately in CHI’s consensus-driven culture. Wilson adds that the administrative residency component of Trinity’s MHA program “taught him to connect the dots,” and experience everything from the governance of a hospital to the operations of the entire provider network.
“That exercise, in addition to the program’s didactic portion, is invaluable for those in health care management,” Wilson says. “It is a great value to have the ability to connect the dots and see how entities interact along the continuum of care.”
In addition to his work in population health, Wilson is also president of Trinity’s Denver alumni chapter. Nearly 1,000 of Trinity’s 29,000 living alumni reside in the Centennial State. Wilson says he and the Colorado board exist to activate alumni and keep them connected not only to one another but with the University as well.
Since moving to Colorado, Wilson and his wife Kate have befriended Trinity alumni from a wide variety of decades. They are able to bond over the “amazing shared interest of the University” and reminisce about San Antonio memories. In their spare time, the Wilsons love to cycle, camp, and are almost finished restoring their 1983 Volkswagen Westfalia with their family.
Look for Tyler Wilson cruising down the open road soon, or, just maybe, leading a CIN near you.
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