Three questions with Megan Carr: Why risk adjusting is a vital element to get us to value-based care and beyond

Oct. 5, 2022 / By Megan Carr, Kelli Christman

I sat down with the 3M Health Information Systems Vice President of Regulatory and Payer Solutions Megan Carr to talk about her new role as the leader of our payer team, the importance of risk adjustments and trends for 2023.  

Congratulations on your new role Megan! You’re a veteran blogger for Inside Angle, but can you tell us a bit about your background and your current role with 3M HIS? 

Thanks! I started my career working on the Hill for a member of Congress who served on the Ways and Means Committee and the Medicare Subcommittee. I then moved to a health care trade association where 3M was a member. I’m a Minnesotan, so I was familiar with 3M and knew it was a place I would enjoy working. I’ve been here for 14 years, and in 3M HIS for about four of those years. While I am amazed by all that 3M does across the company, I was really drawn to 3M HIS’ mission to make health care more effective. I love that we have the opportunity to sit down with states, payers and providers, figure out what their pain points are, and help them design solutions that meet their needs.    

Pulling the payer team together with the regulatory team allows us to meet the needs of all payers, both government and commercial, to drive value and quality across the health care system. We see similar needs for all to set payments based on established and tested payment groupings, better understand patient populations through risk adjustment, and align value programs and payment incentives to quality outcomes – and are glad that 3M can be part of the conversation to match those needs.   

Let’s dive right into value-based care. Can you share some examples of how risk adjustment is driving the shift from volume to value? 

The need to go from volume to value is more than just a cost issue – it’s about system efficiency, provider effectiveness, and most importantly, patient outcomes. As a country, we need to see better returns on the significant investments we make into the health care system. I strongly believe that core to this is to risk adjust correctly. If we don’t understand the health needs of the patients being served, we won’t get the value model right. Value programs need to go from just managing costs to truly managing quality and outcomes. And, if we’re going to correctly manage quality, we need a solid risk adjustment program that can enable us to compare apples to apples.  

Part of the value paradigm must also be equity – and value across all patients. We need to be able to compare patient cohorts and make sure that patients with similar health risks are getting the same level of care. We also want to make sure that risk adjustment can support a longitudinal look at how a patient is being cared for and how we’re managing that person over time. Is that individual staying healthy or are they getting sicker? Risk adjustment can support all of that if it is sophisticated enough. We want the system to be better than just “good enough.”  

As we enter into the final months of 2022, what are some trends you see on the horizon for 2023? 

Well, a big thing on the horizon is the election. Whoever wins the House and/or Senate will impact the priorities of issues Congress addresses. But there are some bipartisan areas within health care that will continue, such as the need to do more around value, equity, data and mental and behavioral health.   

We’ve discussed value – and both sides will continue to push us down that path. Everyone knows it is the right thing to do, but it is not simple. I think it is wise to look at examples, such as many things we see happening in the states today, for approaches that work and where to focus our efforts.  

COVID-19 taught us that there needs to be a real focus on equity too. The Biden administration started with an executive order directing all agencies to look at equity; and it’s happening step by step. In 2023, I think we’re going to see much more traction. But again, this is going to require sophisticated risk adjusting to make improvements in that space. 

It’s difficult to focus on equity if you don’t have the key components in the data sets, so the discussions around the content of the data, such as the inclusion of SDoH Z codes, will continue along with the issues of accessing the data. Also tied to equity is the focus on maternal health. The Centers for Medicare & Medicaid Services (CMS) have approved the expansion of Medicaid programs for postpartum mothers for 12 months for more than 20 states, and I think that will eventually expand to almost every state over time.   

I also think that a focus on mental and behavioral health will continue to get a lot of attention as it is an incredibly important topic. We need to figure out how to both expand access to coverage and provide more services within that coverage. In the past, some programs carved out mental and behavioral health, but that has left them out of focus – and there is interest now in pulling them back to ensure they receive the support they deserve.  

If there is a change in leadership in the House or the Senate, we’ll likely see a prioritization on access to insurance coverage, new coverage options, overall cost and spending, quality and transparency. Regardless of the issue, it’s rewarding working for a company that has so many innovative and powerful solutions to help states, payers and providers on these and other emerging initiatives. 

Megan Carr, head of the regulatory and payer solutions team at 3M Health Information Systems. 

Kelli Christman is senior marketing communications and strategic communications specialist at 3M Health Information Systems.