Every month, Evolent Health rounds up some of the latest value-based care news from the previous month spanning policy, research, innovations, payers and providers.
Top Trending Themes
- Full steam ahead: Humana reported lower medical costs for Medicare Advantage members receiving care from physicians paid via value-based models…and announced more value-based arrangements with providers.
- Humana's study found that medical costs were 20% lower for seniors enrolled in Humana Medicare Advantage plans that paid physicians via value-based models compared to costs for those in traditional fee-for-service Medicare. Humana's report also outlined 27% fewer hospital admissions and 15% fewer emergency rooms visits for health plan members whose doctors were paid via value-based models when compared to fee-for-service Medicare.
- Humana also announced value-based agreements for Medicare Advantage members. Among those deals:
- Collaborating with Epione Health of Oklahoma on a value-based agreement designed to offer a coordinated, patient-centered experience. Epione's model places primary care physicians at the center of health care and supports their operational, technology and practice management needs.
- Collaborating with Hawaii Senior Medical Group, the local division of Seoul Medical Group, which also has relationships with Humana in California, Washington, Georgia and New Jersey.
- Advanced primary care organizations show no signs of slowing down, as they rapidly expand their presence across the country.
- Oak Street Health, which serves patients on Medicare in medically underserved communities, opened its first primary care centers in North Carolina, two in Greensboro and Charlotte, with a third center in Charlotte under development. North Carolina Medicare patients enrolled in United Health and Humana's Medicare Advantage plans will have access to all three centers in the state. Oak Street also opened a new primary care center in Youngstown, Ohio, its fourth in that state.
- ChenMed plans to add five new markets—across Ohio, Tennessee, Missouri and Florida—in addition to launching new Dedicated Senior Medical Centers in its 14 existing markets. Offering concierge-style medicine to seniors, ChenMed has seen rapid growth since its launch in 2010, with average annual growth of 35%. This new expansion will bring its presence to nearly 80 centers in 10 states.
- Tele-behavioral health is seen as a growing area to better serve the mental health needs of commercial populations.
- American Well acquired Aligned Telehealth, a provider of digital behavioral health services to hospitals and health plans, to expand behavioral health access and treatment to their employer, payer and health system partners. A national telehealth organization, American Well hopes to leverage Aligned Telehealth's clinical network, along with its own digital care delivery platform, to deliver programs that empower hospitals and health plans to address clinician shortages and fragmented behavioral health care.
- Aetna Behavioral Health inked an agreement with Workit Health, a provider of digital addiction care via web and phone apps, for its fully insured members in California and Michigan. Workit Health's online addiction care program offers therapy and medication management from licensed clinicians. Members can receive treatment from Workit Health's web and phone apps, including therapy from licensed counselors and a personalized curriculum of evidence-based interactive courses, without a referral.
- Self-insured employer Walmart has teamed up with video telemedicine company Doctor On Demand to provide virtual primary care with integrated behavioral health care to Walmart employees in Colorado, Minnesota and Wisconsin. The partnership will provide Walmart employees with a primary care physician and care team and aims to improve preventive health care for people with chronic conditions. Walmart is self-insured and contracts directly with Doctor On Demand to provide telemedicine services while offering services to their employees for a $4 copay.
- Google Health builds upon its core capabilities as it stakes out a greater role in health care.
- Google has partnered with Ascension Health to provide a comprehensive data platform for Ascension patients. The two organizations are already testing software that allows providers to search and analyze a patient's medical history, with the goal of providing data-driven insights that inform treatment and give medical professionals better access to patient data. Although health systems are legally allowed to share patients' medical information with third-party business partners such as electronic medical record companies, Ascension's partnership with Google has been met with some controversy due to Google's past violations of privacy laws.
- Google Health is also looking to capitalize on Google's core expertise by integrating search functionality into electronic medical records and improving the quality and availability of health-related information on Google and YouTube. This effort seeks to address two separate challenges: enhancing search functionality in electronic medical records so physicians spend less time looking for and recording medical data, and improving consumer health searches so people who look online for a diagnosis receive correct information. Google is working with the Mayo Clinic to source better health content, and it introduced a screening for clinical depression in 2017.
Payers and Providers
- Remedy, a software company that enables payers and providers to organize and finance health care delivery around a patient's episode of care, has partnered with Regence, a health plan covering four Western U.S. states. Regence's new member-centered, value-based program, called Episodes of Care, will pay participating physicians for improved outcomes and lower costs over a patient's entire episode of care, covering all the care a patient receives for a procedure or condition over a specific period of time. Regence will start the program with orthopedics and maternity, and it expects to expand into cardiovascular, gastroenterology and chronic conditions. Episodes of Care will launch in Washington in 2020, with plans to eventually spread into Utah, Oregon and Idaho.
- UnitedHealthcare and Walgreens are opening 14 UnitedHealthcare Medicare services centers within Walgreens stores in five metropolitan areas as part of a multiyear agreement. The UnitedHealthcare Medicare services centers will begin to open in January 2020 at Walgreens stores in the Las Vegas, Phoenix, Cleveland, Denver and Memphis markets. Through these centers, Walgreens customers can learn more about Medicare, meet with service advocates to discuss their UnitedHealthcare plan benefits, and enroll in plans. UnitedHealthcare Medicare Advantage members can also make an appointment for an in-store annual wellness visit at the Medicare services center in Walgreens through UnitedHealthcare's HouseCalls program.
- L.A. Care Health Plan and Blue Shield of California Promise Health Plan held a ribbon-cutting ceremony for their first jointly operated Community Resource Center. The new center is part of the $146 million commitment announced in September 2019 to jointly operate 14 such locations across Los Angeles County that will offer a variety of exercise, nutrition and health management classes in a safe, fun and inclusive space for residents at no cost. This is the first of seven new centers that will open in the coming years; seven existing centers will be either renovated or moved to larger locations.
- The Blue Cross Blue Shield Association, a federation of 36 independent Blue companies, is launching a Blue high-performance network, a program designed to direct patients toward health care providers who consistently offer high-quality care at lower costs. The high-performance network, aimed at large national and regional employers, is set to launch in January 2021 in 55 markets and reach 185 million people nationwide.
- Blue Cross NC signed value-based, multiyear agreements with Atrium Health and Novant Health, two of North Carolina's largest health systems. Both systems are joining Blue Cross NC's Blue Premier value-based program, a contractual arrangement that holds the systems and Blue Cross NC jointly accountable for better health outcomes, an improved patient experience and lower costs. The addition of Atrium Health and Novant Health means that seven of the state's largest health systems are participating in Blue Premier beginning in 2020. The agreements put Blue Cross NC on track to meet its goal of having 50 percent of its members served by providers in value-based, shared-risk agreements in 2020.
Accountable Care Organizations
- Genesis HealthCare, an ACO specifically focused on long-term care residents, hopes to expand its enrollment by 3,000 beneficiaries in 2020 through partnerships with third-party, non-Genesis facilities. The Pennsylvania-based ACO currently serves 6,400 Medicare enrollees and achieved $1.7 million in savings in 2018. Jason Feuerman, Genesis' senior vice president for strategic development and managed care, argued that Medicare ACOs are an overlooked model for long-term care providers and can drive similar savings and outcomes as an Institutional Special Needs Plan on a more capital-efficient platform.
- The Michigan Oncology Quality Consortium is partnering with Varian, a California-based technology company, to launch a connected health platform in 19 cancer centers across the state. The mHealth app will allow patients to chart their treatment, reporting outcomes and allowing providers to manage their care on the go. The project will identify measures for the Quality Payment Program that improve clinical outcomes to build a new Medicare reimbursement model for oncology.
- The American Oncology Network (AON), an alliance of physicians and health care leaders, expanded its participation in the Oncology Care Model (OCM) by adopting two-sided risk. AON has already seen success in providing high-quality, cost-efficient oncology care through its participation in OCM and hopes that moving to two-sided risk will increase provider engagement and alignment.
- Ascension, CommonSpirit and Highmark Health have signed joint venture deals with Contessa, a Tennessee-based home health startup, to provide at-home hospital care to their populations. The joint ventures with Contessa allow providers to care for the sickest patients in the hospital while moving those who do not require continuous monitoring to their homes. Contessa's technology can flag up to 150 diagnoses that can be treated at home. After further evaluation, a medical team decides if the move home is appropriate. Contessa establishes the reimbursement arrangements with payers for the services and technology it brings to its partner health systems. The health systems use their own clinicians to dispatch to a patient's home. This shift to embracing home health is largely driven by health systems' need to decrease overhead costs and improve patient outcomes as reimbursement is increasingly tied to quality.
Digital Health and Technology
- Amazon released the initial version of a tool that allows patients to manage medications using the company's voice assistant, Alexa. Customers of the supermarket and pharmacy chain Giant Eagle, which has more than 200 pharmacy locations in the Midwest and Mid-Atlantic, are now able to review their current prescriptions, set reminders to take medications and request prescription refills through the new Alexa feature. This skill was developed out of an invite-only program for health care companies that Amazon launched this spring to enable them to develop skills that transmit protected health information through the voice assistant while complying with HIPAA.
- Omada Health and Blue Cross and Blue Shield of Minnesota announced the availability of Omada's Type 2 Diabetes Digital Care program as a covered benefit for the insurer’s commercial plans, building on the two organizations' success deploying digital diabetes prevention in the state. Omada's type 2 diabetes program will be available for Minnesota employers to launch beginning January 2020. Blue Cross also announced a strategic investment in Omada Health through the insurer's parent company.
- Aetna is partnering with Miami-based Papa Inc. to connect seniors with college-age caregivers. Beginning in January 2020, Aetna’s partnership with Papa will be available to certain Medicare Advantage members in Florida who have one or more chronic conditions so that they can receive assistance via Papa Pals. Papa has partnerships with various Medicare Advantage payers, including Humana, WellCare Health Plans and Alignment Healthcare.
- Aetna Better Health of Pennsylvania is partnering with Babyscripts, a virtual care platform that connects expectant mothers with their doctors, to deliver pregnancy care solutions to plan members at participating WellSpan Health sites. The partnership will focus on increasing access to care for pregnant patients through remote monitoring and virtual care. In the past two years, Babyscripts has increased its partnerships with health systems, OB-GYN practices and health plans, including Cone Health, Atrium Health, Penn Medicine, WellSpan Health and Axia Women's Health. Babyscripts now manages more than 150,000 pregnancies across 20 states.
- Geisinger Commonwealth School of Medicine is offering free tuition to students who agree to practice primary care at Geisinger Health after residency. The health system anticipates a shortage of approximately 300 family medicine physicians by 2022, which is aligned with the national trend of primary care shortages. Free tuition will be available to 40 of the 115 total students as part of a competitive application process integrating financial need, diversity, academic merit and passion for primary care.
- To alleviate the high burden of medical school debt, the University of Arizona medical school is offering free tuition to students who commit to working as primary care doctors in underserved areas. For each year of tuition waived, students will have to commit to working in a lower-income region for one year after their residency. The scholarships will only be available to Arizona residents specializing in family medicine, general internal medicine, geriatrics, pediatrics, psychiatry and obstetrics and gynecology.
- UT Health Science Center at Tyler and Blue Cross Blue Shield of Texas are collaborating on a doctoral program to train health care professionals in population health, as well as working on a study of the costs of behavioral health treatment. The doctoral program aims to provide a holistic experience for health administration professionals in population health management, integrating knowledge from payers, providers and academics. The behavioral health study seeks to quantify the long and short-term costs of behavioral health care with the goal of identifying cost-effective ways to manage mental health issues.
- The American Medical Association released a policy encouraging medical schools and residency programs to include information about health financing and economics in the curriculum. The AMA recommends that programs address different payment models, cost-effective sites of care and treatment options, and risk management.
- Highmark is launching a comprehensive program focused on hemophilia to reduce spending and improve care for this high-cost population. Highmark is partnering exclusively with three companies—Option Care Health, Inc., Soleo Health and the Hemophilia Center of Western Pennsylvania—and the providers will have performance guarantees and oversight protocols. Of Highmark's 4.5 million members, approximately 190 have a hemophilia diagnosis, and the health plan says it spends about $80 million annually on their care, with pharmacy costs comprising about 90%. As a result of the initiative, members and health plan clients are expected to see potential cost savings of approximately 15%.
People on the Move
- Dr. John Halamka will join Mayo Clinic to lead its new partnership with Google that aims to leverage artificial intelligence to improve health care. Halamka will be leaving his post as executive director of the Health Technology Exploration Center at Beth Israel Lahey Health in Boston to assume the role as the president of Mayo Clinic Platform.
Evolent in the News
- After the Trump administration issued new rules for hospital and insurer price transparency, Evolent Vice President of Health Policy Ashley Ridlon told Modern Healthcare that the debate needs to go beyond prices. "Sometimes there's a perception that more expensive means better. Quality information should be more clearly communicated to patients, not just cost. There needs to be something of a culture shift around patients seeking out higher value services."
Government and Regulatory
- The CMS Home Health Prospective Payment System rule was finalized, creating a new home infusion therapy benefit and increasing payments to home health agencies by an estimated $250 million for the calendar year 2020. The home infusion therapy benefit, which will be implemented in 2021, will cover the administration of certain medication through a durable medical equipment pump in a patient's home. It will also cover professional services such as nursing, patient education and training and patient monitoring. The home health payment rule also implements a new case mix payment method for home health services that relies on a patient's characteristics, which led CMS Administrator Seema Verma to state: "The final rule rewards value over volume by focusing on patient information such as their diagnosis and other health conditions, to more accurately pay for home health services."
Survey Says/Studies Show
- A study commissioned by the National Association of ACOs found that ACOs lowered overall Medicare spending by $755 million from 2013 to 2017. Since the program's inception, ACOs have been able to increase savings year-over-year, lowering Medicare spending by a rate of 1% to 2%. Consistent performance from ACOs, combined with the fact that ACOs tend to drive more savings the longer they are in the program, indicates that MSSP has been one of the most successful value-based models CMS has tested.
- More than half of commercial payments to providers are tied to the value of services in some way, yet most of the payments are built on a fee-for-service foundation and few pose any downside risk to providers, according to the latest national scorecard from the Catalyst for Payment Reform. No payment method posing downside risk to providers has accounted for more than 4% of total payments in any year studied. The lack of downside risk contributed to the organization's finding that value-based payments are not moving the needle on the cost and quality of care. The Catalyst for Payment Reform has tracked the implementation of value-based payment among commercial payers and employers since 2012.
- An observational study published in JAMA Internal Medicine gives the TV show "Grey's Anatomy" some credit for increasing awareness for a sexual assault hotline. Researchers examined the impact of a March 2019 episode that centered on the theme of sexual assault. At the end of the episode, actress Ellen Pompeo urged viewers to seek help and provided the contact number for the Rape, Abuse & Incest National Network (RAINN) hotline. The researchers found searches on Google specifically for the term "RAINN" were 41% greater than expected following the episode, and telephone calls to the RAINN sexual assault hotline increased 43% in the 48 hours after the episode released.