Value-Based Care Intelligence Digest - June 2018

June 11, 2018

Every month, Evolent Health rounds up some of the latest value-based care news, spanning policy, research, the provider community and how our partners are helping to improve the health of their communities.

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Top Trending Topics

  1. It’s busy season for healthcare investment bankers!
    1. Anthem agrees to acquire Aspire, continuing the ongoing trend of payers vertically integrating with providers of patient care (Aspire manages end-of-life care in lower-acuity settings for payers). The acquisition also manifests Anthem’s strategy to create their own managed services business unit targeting other payers.  Aspire will be housed alongside IngenioRx and AIM, two other examples of outsourced line-item benefits management (“XBM”) for payers. 
    2. Partners Healthcare System seeks to acquire Harvard Pilgrim Health Plan. Partners advanced their health plan strategy as talks of merging with Harvard Pilgrim (1.2 million lives) went public.
    3. Wellcare agrees to acquire Meridian Health Plan for $2.5 billion.  This move continues their strategy of consolidating regional Medicaid and Medicare Advantage plans (e.g., Meridian and Universal American, respectively, costing over $3.3 billion).
  1. Two unicorns…and Big Blue:
    1. Iora raises another $100 million, bringing their total capital raise to ~$225 million. High-performing primary care capacity for Medicare Advantage continues to be a magnet for venture capital despite the large capital outlays required to achieve scale in brick-and-mortar operations.  Of note, Humana joined the latest funding round.
    2. Oscar reports a Q1 profit, a sign that their commercial narrow network product can achieve profitability at scale.
    3. IBM Watson Health reportedly lays off 50-70% of its workforce after spending over $3.6 billion to acquire Explorys, Phytel, and Truven in the past 3 years.
  2. Momentum toward new value-based care models:
    1. A new advocacy group, the Partnership to Empower Physician-Led Care (PEPC) has been formed by a coalition including independent primary care physicians -- including AAFP, MGMA, and the California and Texas Medical Associations -- to advance physician-friendly Advanced Payment Models and creative participation in Medicare Advantage.
    2. BCBS Ventures made two investments in innovative care models aimed at lowering costs and improving quality for payers: Somatus, which manages high-cost chronic kidney disease patients for payers, and Contessa, which delivers acute-care level services in the home (another variation of “home health”).

PROVIDER SPOTLIGHT

Each month, we highlight new or novel steps being taken toward value-based care and population health.

Evolent Partner News

  1. Evolent announced its partnership with SOMOS IPA to accelerate value-based care in New York. The partnership will first focus on supporting the performance goals of New York’s Delivery System Reform Incentive Payment (DSRIP) program for about 300,000 New York residents and will lay the groundwork to expand to other value-based care arrangements.
  2. Evolent Health’s client, Lee Health, was notified by the Florida Agency for Health Care Administration (AHCA) of its intent to award a contract to Lee’s affiliate, Best Care Assurance, LLC, to launch a provider-sponsored Medicaid plan. Lee Health is also a participant in the Next Generation ACO program for the 2018 performance year, which Evolent will support by delivering technology, analytics and clinical programs to deliver higher quality, lower cost care.
  3. Evolent Health’s clients, Nicklaus Children’s Health System and Baptist Health Care, have been notified by the Florida Agency for Health Care Administration (AHCA) of its intent to award a contract to Miami Children’s Health Plan (an affiliate of Nicklaus Children’s Health System) and Lighthouse Health Plan (an affiliate of Baptist Health Care) to provide physical and behavioral health care services through Florida’s Statewide Medicaid Managed Care (SMMC) program.
  4. John Chomeau, Chief Population Health Officer at a leading health system in Florida, shares his thoughts on how working with Evolent Health accelerated new opportunities in value-based Medicare and Medicaid.

General Updates

  1. Intermountain launches Homespire in collaboration with a home care management and senior living services provider to create a new care model for seniors including private-pay home care options.
  2. The American Heart Association (AHA), UPMC and Philips are teaming up in $30 million venture capital fund to invest in heart disease and stroke care products. Each organization will put in $10 million into a fund called Cardeation Capital.
  3. The Blue Cross and Blue Shield Association launches The Blue Cross Blue Shield Institute to address social and environmental issues. The Institute will address the “zip code effect” which will include transportation, pharmacy, nutrition, and fitness deserts in specific neighborhoods. It will partner with Lyft, CVS and Walgreens among other companies.
  4. UnitedHealthcare and Quest Diagnostics establish a long-term strategic partnership to create more personalized care recommendations and a simpler consumer experience. The two organizations will collaborate on a number of value-based programs around lab services real-time data sharing.
  5. UnitedHealthcare’s Spine and Joint Bundled Payment program reduced hospital readmissions by 22% and complications by 17%. Participating employers saved nearly $18 million, an average of $18,000 a procedure. Members saved more than $3,000 in out of pocket savings per procedure. As a result, UHG will expand its bundled payment models to 37 markets from 28.

GOVERNMENT, REGULATORY, AND INDUSTRY PULSE

CMS

  1. CMS’s Comprehensive Primary Care (CPC) Initiative slowed growth of emergency department visits by 2%, but did not reduce Medicare spending enough to cover care management fees or improve physician or beneficiary experience.
  2. During the American Hospital Association Annual meeting, CMS Administrator Seema Verma cited patient care and payment design as necessary to further the progress of value-based care reforms. She noted that CMS is dedicated to promoting quality based reimbursement, consumer directed healthcare and cost transparency.

Federal

  1. President Trump wants foreign countries to increase what they pay for U.S drugs and called existing payment practices “global freeloading.” In an earlier report, the White House Council of Economic Advisers noted that profit margins on brand-name drugs in the U.S. were four times higher than those in some major European countries.
  2. HHS Secretary Azar spoke at the World Health Care Congress, pushing healthcare systems to embrace value-based care and introducing the concept of direct provider contracting within Medicare. He vowed to make value-based care models easier for providers to build and sustain.     
  3. Clover Health testified before the House Ways and Means Committee to ask the federal government to loosen requirements around network adequacy to increase competition in light of health system consolidation.

EVOLENT IN THE NEWS

Follow our Knowledge Center for additional insights.

  1. Houston Methodist’s Dr. Julia Andrieni and Evolent Health’s Vice President of Clinical Transformation, Dr. Michael Udwin, provide insightful learnings about reducing physician burnout. Read the full case study in Medical Economics.
  2. Chris Dawe, Evolent Health’s Vice President, discusses whether the ACA repeal will be back on the political agenda next year in this Fierce Healthcare piece.
  3. Physicians from Houston Methodist in Texas and Deaconess Health System in Indiana sat down with Hospital Peer Review to share how their population health initiatives, with the support of Evolent Health, have led to better health outcomes for their patients. You can check out the Hospital Peer Review article here (subscription required).

STUDIES SHOW

1.According to a CNBC report, new healthcare start-ups are shifting their focus to serve Medicare and Medicaid patients to capitalize on CMS rewards and incentives for improving the health of older and low-income individuals.

2.A UnitedHealth Foundation report used 34 measures of senior health to report successes and challenges the senior population faces on a national and state by state basis. The report found:

a.Poorer health for rural seniors

b.The national suicide rate among seniors has increased 12% since 2014.

c.Food insecurity decreased 7% in the past year

d.Utah, Hawaii, New Hampshire, Minnesota and Colorado are the top 5 healthiest states for seniors. 

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