Value-Based Care News Digest - November 2019

November 11, 2019

From promising startups to major retailers and even a few celebrities, the quest for value is drawing broad interest. Read this month's news roundup to keep tabs on the action, as well as the latest research and regulatory changes affecting the field.


Top Trending Themes

  1. While new clinic entrants (Walmart and CVS) aggressively pursue wholly owned clinics as part of their health care strategy, a veteran (Walgreens) has abandoned that approach.
    • At the HLTH conference in Las Vegas, Walmart gave a virtual tour of its first "health care supercenter" clinic in Georgia while CVS also highlighted its HealthHUBs, which it plans to expand to 1,500 stores in the next two years.
    • Walgreens has owned and operated clinics across the country for years, yet the wholly owned clinics consistently lost money for the company. They will shut down 150 of their clinics this year and will instead rely on third-party partnerships (e.g., with VillageMD) to operate clinics moving forward. The pivot is part of a $1.8 billion savings initiative. Walgreens' exit raises the question: What can CVS and Walmart learn from Walgreens' experience?
  2. Major payers are accelerating their pace toward value and making investments in innovation (while also clamping down on fee-for-service).​​​
    • UnitedHealth Group
      • Teaming up with its OptumCare medical care provider business in Southern California to launch a new employer-based health plan, now serving 1.5 million members in value-based arrangements. In addition to UnitedHealth, Aetna/CVS and Humana/Walgreens and other providers are expected to launch similar health insurance products that combine medical care with health insurance.
      • Announced a new policy, effective Nov. 1, that requires prior authorization for outpatient surgeries performed in a hospital setting. The policy is meant to encourage physicians and patients to perform planned surgeries in ambulatory surgery centers, which can cost up to 50% less than the same surgery performed at a hospital.
      • Through Optum, acquired Vivify, a remote patient monitoring startup that provides devices such as wireless weight scales and portable blood pressure cuffs to remotely track at-risk patients.
    • Blue Shield of California​
      • Piloting a fully digital, real-time claims payment system with Dignity Health to eliminate excessive paperwork and allow providers to collect payment immediately. Physicians and members will use a fully digital payment system that will deliver the bill immediately and allow patients to choose whether to pay all at once or in installments. Blue Shield of California hopes to have real-time claims for all members in California by 2023.
      • Partnering with Notable Health to provide physicians with a natural language processing tool to input patient records through a convenient tool such as the Apple Watch. One clinic reported this summer that the tool cut 1-2 hours of EHR time per day.
    • Humana
      • Invested $20 million in Accolade, a data platform that integrates personal health data and health plan information with other insights and tools.
      • Leveraging Microsoft's Azure cloud platform to provide Medicare Advantage beneficiaries with targeted health information and care teams with complete health records, helping them make timely, informed decisions on patients' behalf.
  3. The 2018 ACO results from CMS have shown both an increase in ACOs assuming downside risk and overall savings, yet hospital-based ACOs saw varying results.
    • The first year of Pathways to Success saw a larger proportion of ACOs taking on downside risk, with large, physician-led ACOs most likely to take on downside risk.
    • Baylor Scott & White, Ochsner Accountable Care Network and other large, experienced ACOs are continuing to drive increased savings year-over-year through value-based care initiatives such as comprehensive care management, provider and patient outreach and predictive analytics.
    • In large metropolitan markets such as Chicago, there was significant variance in hospital-based ACO performance, demonstrating that many hospital-affiliated groups struggled to control spending. Despite these challenges, investing in value-based care initiatives such as predictive analytics and addressing social determinants of health has paid off for some ACOs in the area.

Industry News

Primary Care

Chronic Disease

Home Health

  • Heal, a home health startup backed by Lionel Richie and Jeb Bush (you read that right), has raised $75 millon in venture capital. The Heal app operates much like a concierge service, where patients can input their medical and insurance information and receive a house call from a primary care physician and medical assistant within two hours. The physician can perform tests such as EKGs, ultrasounds and blood tests, while also assessing a patient's living conditions and access to food or prescriptions. Heal has grown rapidly over the last year, increasing revenue by 310%, and it has attracted partnerships with major commercial and Medicare Advantage payers. Heal anticipates more than 100,000 house calls in 2019, with hopes to expand outside its current metropolitan markets moving forward.


General News

People on the Move

Government & Regulatory


Evolent in the News

  • Evolent became the first organization to receive Population Health Program (PHP) Accreditation from the National Committee for Quality Assurance. The PHP program will replace NCQA's longstanding Disease Management program, a transition that reflects the growing emphasis on a more proactive, whole-person approach over a reactive one focused on specific health problems. For perspective on the accreditation and the trajectory of population health in general, read our recent blog post.

Survey Says/Studies Show

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