The State of Value-based Care and HSG’s Continuing Manchester Connection.

Post Written by Jason Helgerson, Founder and CEO

I recently returned from my annual Easter trip to England. While my work takes me to England multiple times yearly, I always make a special trip around Easter weekend.  A key reason for the journey is HSG’s continuing sponsorship of FC United of Manchester football club.  

Since 2019, HSG has sponsored the club’s team for people with disabilities. As part of our sponsorship, we always sponsor a match on Easter weekend. FC United is a non-profit, community-focused club that adds tremendous value to its community. We are thrilled to be part of the FC United family, and I love the opportunity to reconnect with the club and its supporters each Easter. 

My Easter trip isn’t all football.  I also use the opportunity to crisscross the country as part of our work overseas.  HSG has been active in England since the firm’s founding.  In addition, my ties to the country go back to my days as New York State Medicaid Director when I allied with NHS England’s Vanguard Program, which, much like the DSRIP program  I was leading, was trying to harness the power of integrated, accountable care to improve population health.  Both programs achieved some significant successes and laid the groundwork for future work.  

A key outcome of DSRIP was the massive acceleration in value-based care in New York.  Led by Medicaid, the state is now at the forefront of value-based care and contracting.  Leading this effort made me believe in the importance of value-based care and its ability to achieve better alignment between healthcare purchasers and providers.  Effective value-based care allows a health system to focus on meaningful outcomes and effective care integration, which will drive massive improvement in population health and achieve cost efficiency.  

Value-based care is also a global movement that takes different forms in different countries.  Every nation I have visited has its unique challenges, but all suffer from misaligned incentives, care siloes, and a lack of clarity and focus on meaningful outcomes.  While all nations have their strengths, all struggle in different ways.  There is much we can learn from each other, and HSG is committed as a firm to helping share best practices globally.  

During this year’s Easter trip, I spent time in Manchester and London. While in Manchester, I met with top officials from hospital trusts and the NHS England regional authority overseeing Greater Manchester’s health system. Manchester is fascinating because it was given significant regional autonomy in recent years and used that flexibility to innovate and work cross-system.  

What I heard in Manchester was increasing optimism around the possibility of meaningful value-based care.  All parties were excited to have a stable national government that appears well-positioned for the long run and increased opportunity to break free from some of the limitations of the past.  That said, England continues to struggle with the fallout of the pandemic, which has put significant pressure on the system to reduce waitlists and maximize “through-put” efficiency.  

I heard meaningful discussions about moving services out of the hospital and back into the community and a strong desire to achieve regional agreement on what “accountable care” should look like in GM. These comments are hopeful signs for GM's future direction of value-based care.

In London, I met with officials from the newly empowered Department of Health and Social Care. The new Labour Government's recent decision to merge NHS England into the DHSC has fundamentally shifted power and policymaking to the department. The department is working on its next 10-year plan, which could set the policy direction for this parliament and the next.  

DHSC staff were excited about the opportunity before them. After years of national government tumult, they are pleased to have stability and energy from the Secretary of State and his team. While the resource levels are not as high as anyone would like, they are excited about the opportunities presented by the new 10-year plans.  

My conversations with the team were focused on value-based care, which led naturally to a discussion about the meaning of “strategic commissioning.”  For my fellow Americans… commissioning is what we call contracting and is the primary way government purchasers can achieve incentive alignment with healthcare providers.  I strongly encouraged them to make the move to strategic commissioning meaningful but also realistic.  The lack of adequate resources prevents massive shifts, but given the 10-year window before them, there is a chance to provide a multi-year glide path to incentive alignment and greater focus on outcomes that matter.  

I ended my trip with Roy Lilley .  Roy is a bit of an NHS legend.  Among his many pursuits, he publishes a daily post that hundreds of thousands of people across the country read.  He is known for his willingness to speak truth to power while celebrating NHS success through The Academy of Fabulous Stuff.   

As the video above shows, Roy believes value-based care should be the NHS’s future, but he is clear-eyed about the challenges ahead. His questions about how “value” is defined and measured must be answered. I, for one, have advocated that the NHS adopt the same measure set we used in NY DSRIP—avoidable hospital use—as the North Star for their efforts.  Avoidable hospital use measures tie nicely into the waitlist challenge, and they represent a meaningful measure of the overall performance of the health and social care system. Every health system worldwide should use those measures to help judge their effectiveness.    

As always, my Easter trip across the pond was enjoyable and illuminating. I remain bullish on Manchester’s ability to innovate and lead in health and social care integration and the country as a whole. HSG will continue to stay engaged in the country, and we look forward to meaningful work in England well into the future.  

Curious to learn more about how policy changes are impacting the Medicaid space? We’re here for you, whether you’re a provider taking risk or an ACO/IPA, or seeking to enter the Medicaid market. Contact us and we’ll arrange a time to talk!

About the Authors: Jason Helgerson is the founder and CEO at HSG, and was previously the Medicaid Director for New York State. Follow him on X and connect with him on LinkedIn.