Value-Based Care News Digest - May 2019

May 8, 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 Topics

  • Value-based primary care models are in expansion mode, as companies add new payer partners, raise capital and expand to new locations.
    • Most of these companies are using partnerships with major payers to expand to new states and regions.
      • Cityblock and Iora Health announced in March that they will expand their clinics into North Carolina with Blue Cross and Blue Shield of North Carolina as their anchor payer partner.
      • Sanitas USA will open 10 integrated primary care centers in Texas in partnership with Health Care Service Corporation (HCSC), in a potential precursor to a rollout across HCSC’s five states. The medical centers will accept Blue Cross and Blue Shield card holders, self-pay patients and seniors with traditional Medicare coverage.
      • Oak Street has contracted with Aetna to allow any of the payer’s Medicare Advantage (MA) members to seek care at its Indiana and southeast Michigan locations. Oak Street is also adding two new outpatient centers in Flint, Mich., which will be in-network with Health Alliance Plan. Oak Street’s model focuses on offering comprehensive primary care services and dedicated care teams to coordinate patient health needs.
    • VillageMD is partnering with Walgreens to open five clinics adjacent to Walgreens stores in Houston—an apparent response to CVS’ recent launch of HealthHUB locations in Houston.
  • The Centers for Medicare and Medicaid Services (CMS) is making moves in value-based care, announcing new primary care provider-centric programs and increasing flexibility in MA benefits.
    • CMS anticipates enrolling 25% of Medicare fee-for-service beneficiaries into one of its two new risk models that make up its new Primary Cares Initiative:
      • Primary Care First is primarily targeted at smaller practices with less experience in value-based payment models. It offers coordination of care payments and other financial support, with performance-based payments and some financial risk. A version of this model will be targeted at the seriously ill population and will provide extra support for patients who need hospice or palliative care services and effective care coordination.
      • Direct Contracting is for practices with at least 5,000 Medicare beneficiaries and offers a 50% savings/losses risk-sharing option, a 100% savings/losses risk-sharing option and a total care capitation model, which would provide capitated, risk-adjusted monthly payments for all participants and preferred providers.
    • CMS is offering benefit flexibility to MA plans, allowing non-medical in-home care as a supplemental benefit for MA plans in 2019. For 2020, CMS also announced that MA plans can cover any benefit that is "likely to improve or maintain the health of beneficiaries with chronic conditions."
  • "The doctor will see you on your iPhone now": Payers expand telehealth capabilities.
  • Health systems continue to merge: Atrium becomes a 50-hospital system in North Carolina, and systems in New York and Connecticut combine.

Industry News


Payers and Providers

Social Determinants of Health (SDOH)

Government & Regulatory PULSE



Evolent News

  • In a blog post, Vice President of Health Policy Ashley Ridlon recently weighed in on the promise of CMS’ highly anticipated Direct Contracting model as the next step in the evolution from volume to value, as well as the challenges the model may face.
    • Ridlon was quoted in a Healthcare Innovation story about Direct Contracting, and Axios quoted Chris Dawe, Evolent Senior Vice President for Medicare Partnerships. 
  • Evolent recently launched a new series, The Heart of Care, to show how our care management teams are helping to change the health of the nation, one patient at a time. Read an introduction to the series by CEO Frank Williams and the first success story, highlighting the importance of taking a whole-person approach to complex health problems.

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