Value-Based Care News Digest - December 2019

December 12, 2019

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

  1. 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.
  1. 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.
  1. 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.
  1. Google Health builds upon its core capabilities as it stakes out a greater role in health care.

Industry News

Payers and Providers

Accountable Care Organizations


Home Health

  • 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


Rare Diseases

  • 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

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


Survey Says/Studies Show



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