Value-Based Care News Digest - October 2019

October 10, 2019

This month's news roundup highlights major retailers entering the health care market, higher earnings for ACOs taking on downside risk, and the latest research mapping the growth of value-based care. 


Top Trending Themes

  1. Established retailers are looking to carve out their own niche in the health care industry.
  • Best Buy has made several acquisitions over the past year indicating that it plans to become a major player in the digital health market by selling health monitoring devices for seniors. These acquisitions include GreatCall, a provider of mobile phones and emergency concierge and monitoring services for seniors; Critical Signal Technologies, a remote patient monitoring system; and BioSensics, a predictive health care technology company.
  • Amazon continues to build its health care business by piloting a telehealth clinic for its Seattle employees. The Amazon Care offering includes an in-app visit with a doctor, a nurse practitioner or a registered nurse, and it can be used for urgent health care issues such as colds and infections, preventative health consults, sexual health services and vaccines and lab work. Although a launch of Amazon Care to the general public is not expected for some time, it is likely that Amazon sees telemedicine as a market it can disrupt.
  • Sam's Club is piloting a discount program with big-name health care companies (Humana, Quest Diagnostics and others) to offer customers bundled health care services ranging in price from $50 to $240 per year. The bundles include free prescriptions for generic medications, prepaid health debit cards, opportunities to save on vision and dental, $1 primary care visits from a smartphone and discounts on alternative medicine services. Called Care Accelerator, the program will be piloted in Michigan, Pennsylvania and North Carolina, with hopes to expand nationwide.
  • Walmart launched several new health care initiatives this month, demonstrating its commitment to growing its health care business:
    • Opened its new, 10,000-square-foot health care "supercenter" in Dallas, Georgia, providing everyday health care services such as primary care, dental and behavioral health. The center is positioned as a direct competitor to CVS' and Walgreens' outpatient health care services.
    • Offering Walmart employees the opportunity to earn bachelor's degrees and career diplomas in health-related fields for $1 per day, helping to organically grow its health care workforce. Employees can apply for one of seven bachelor's degrees or two career diplomas through Live Better U, Walmart's education benefit program.
    • Partnering with Embold Health to pilot a program that will identify high-performing and efficient providers and curate a list for Walmart employees to use to select providers based on their location. The pilot will roll out to employees in Orlando and Tampa, the Dallas-Fort Worth area and Northwest Arkansas starting Jan. 1, but Walmart hopes to extend this benefit to employees nationwide.
  1. The greater the risk, the greater the reward: ACOs in the Medicare Shared Savings Program saw an increase in savings from 2017, largely due to more ACOs taking on two-sided risk.
  • Two-thirds of the 548 Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program produced a combined $1.7 billion in savings in 2018, according to new CMS data. Those savings resulted in a $739 million net gain to CMS, more than double last year’s $314 million. ACOs in downside risk models were more likely to achieve savings, with 59% of ACOs in two-sided risk models earning a bonus, compared to just 32% of upside-only ACOs in Track 1. With significant changes to the MSSP program that went into effect this July, there was a drop in overall participants as risk-averse ACOs left the program.
  • How much money did Track 1 ACOs leave on the table by playing it safe? An Evolent analysis discovered that they would have received $219 million more in shared savings had they taken downside risk in a Track 3 option.
  1. Payers seek partnerships to support value-based care initiatives for line items and reduce barriers for high-need populations.
  • Line-item partnership:
    • Blue Cross Blue Shield of California has partnered with Virta, a digital therapeutics company, to provide value-based care to Type 2 diabetes patients. Virta's program has participants follow a keto-based dietary system and follow up on their progress through an app that provides access to a health coach, an online community of Virta treatment members and other digital support tools housed through Blue Shield's wellness platform, Wellvolution. Virta's value-based payment model is tied to predetermined engagement milestones: If the program fails to reduce patients' blood-sugar levels to within a target range, Virta will not earn the full payment.
  • High-need population partnerships:
    • Seeking to reduce missed appointments and improve outcomes, Blue Cross Blue Shield of California has partnered with Hill Physicians and Lyft to offer free transportation to eligible members in the Sacramento market who do not have access to reliable transportation. The rideQ program is also being tested in other cities including Pittsburgh, New Orleans and Chicago, with the intent to scale should it prove effective in improving patient outcomes.
    • Humana and SeniorLink, a population health services company, teamed up to create Virtual Care Teams to connect digitally with members with multiple chronic conditions and their families, enabling them to maintain their independence and receive support at home. By partnering with Seniorlink, Humana hopes to reduce barriers to contact and increase the overall engagement of members' care teams, thereby alleviating caregiver burden, increasing member satisfaction and decreasing overall cost of care. The pilot will last six months, including up to 250 Humana Medicare Advantage members in 34 states.

Industry News

Payers and Providers

Social Determinants of Health


Government & Regulatory

CMS

Federal


Evolent in the News

  • Healthcare Finance News highlighted Evolent's Social Needs Index, a tool that lets physicians know when a patient's health may be harmed by nonmedical problems such as food insecurity, housing instability and lack of transportation. The index scores patients' social needs based on data extracted from electronic health records, census information and multiple other sources.  

Survey Says/Studies Show

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