Value-Based Care News Digest - June 2019

June 11, 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. Houston, we’re ready for takeoff—of new primary care models.
  • Humana’s subsidiary Partners in Primary Care is opening five senior-focused clinics in the city, expanding on its partnership with the University of Houston to train future health care providers in population health. The Partners in Primary Care centers will be used as learning labs to host University of Houston pharmacy and social work students in rotations. Future rotations will also include physician and nursing students. Partners in Primary Care will provide input for the development of curricula about integrated models of care for the new University of Houston College of Medicine’s class of physicians.

  • CVS Health, which opened three pilot HealthHUB primary care locations in Houston in February, announced that it plans to expand the model to 50 stores this year and 1,500 stores by the end of 2021. CVS' 100 MinuteClinic sites currently focus on low-acuity services such as immunizations and treating colds, yet the company determined that half of the patients who visit MinuteClinics do not have primary care providers. The HealthHUB model will be geared more to everyday health care needs, with a focus on chronic disease management, offering services such as blood draws and sleep apnea assessments.

  • Earlier this spring, HCSC's venture capital arm and Sanitas USA announced they will open 10 primary care clinics for Blue Cross Blue Shield members in Dallas and Houston. Major goals of the clinics will be providing primary care, referring to reasonably priced specialists and offering services like telemedicine and health education.

  • Why Houston? It's one of the fastest growing U.S. cities by population and has attractive MA rates, making it an appealing market for insurers.
  1. New entrants continue to expand MA plans via partnerships with providers.
  • Bright Health will enter five new states in 2020Illinois, Georgia, Florida, South Carolina and Nebraska—bringing its total footprint to 11 states. Bright Health typically partners with an anchor health system for its narrow-network products.
  • Alignment Healthcare and Sutter Health are partnering to launch a new MA plan in Northern California. If CMS approves the application, Alignment and Sutter would begin offering new Medicare Advantage plans in the approved counties in October 2019 and members could seek "in-network" care with Sutter-affiliated and aligned physicians and facilities on January 1, 2020.
  • Troy Medicare is launching a pharmacy-focused MA plan in North Carolina, focused on incentivizing independent pharmacists to deliver care and perform care management services. The plan offers independent pharmacists $30 to $50 per-member, per-month payments for care management services. Troy is developing a data infrastructure that will allow the sharing of pharmacy and medical claims data to help improve care coordination between a member’s provider and pharmacist.

Industry News

General News

Payers and Providers

Social Determinants of Health

Telehealth and Home Health

Government & Regulatory Pulse

Evolent News

  • Evolent expanded its partnership with Passport Health Plan, a Louisville, Ky.-based managed care organizations serving more than 300,000 Medicaid beneficiaries. In the deal, Evolent contributed capital for a 70% ownership stake in the plan and assumed greater management responsibility for day-to-day plan operations.
  • Care management was responsible for more than 50% of the shared savings earned by Evolent partners’ accountable care organizations, an internal analysis found. Read our insight brief to learn what is driving this financial impact.
  • In late May Evolent submitted input to the Centers for Medicare and Medicaid Innovation (CMMI) on its new Direct Contracting payment models. We encourage CMMI to continue the evolution toward full-risk, total-cost-of-care models while providing stability and predictability for those organizations that make the leap.
    • For background on Direct Contracting, read our fact sheet.
  • Evolent and other organizations called on CMS to make permanent the Next Generation Accountable Care Organization model. The National Association for Accountable Care Organizations, America’s Physician Groups, Premier and the Next Generation ACO Coalition say that the success of the Next Gen model warrants codifying it as a full-risk option in CMS’ Pathways for Success ACO program.
  • Evolent’s new series, The Heart of Care, continues to showcase the dedication of our care management experts to their patients. One recent story highlights a Care Advisor's creative solution to help a refugee navigate her health care challenges, while another reveals the behind-the-scenes work to make sure that crucial medical device was not denied to a vulnerable boy.

Evolent in the News

  • Introduced in late April, CMS' Direct Contracting payment model encourages primary care providers to take on two-sided risk. Evolent's Chris Dawe, Senior Vice President for Medicare Partnerships, and Ashley Ridlon, Vice President for Health Policy, spoke with Medical Economics about the factors that could have a significant impact on the program's success.
  • Evolent has created a Social Needs Index that helps physicians and care managers identify patients whose health outcomes may be harmed by nonmedical factors, such as social isolation, lack of transportation or poor access to healthy foods. Vice President for Research and Development Shantanu Phatakwala explains how the index works in Healthcare Tech Outlook.
  • For the fourth straight year, Evolent was listed among the Top 150 Places to Work in Healthcare by Becker's Hospital Review. The publication highlighted Evolent's efforts in employee recognition, wellness, workforce diversity and inclusion, and philanthropy.

Survey Says/Studies Show

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