Value-Based Care Intelligence Digest - March 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. Subscribe to our updates to get the Intelligence Digest delivered directly to your inbox!

TOP TRENDING TOPICS

1. Congress passes Bipartisan Budget Agreement of 2018 which includes new healthcare legislation and spending measures. Trump issues Executive Orders to relax ACA requirements.
   1. Obamacare: The budget agreement repeals the ACA’s Independent Payment Advisory Board (IPAB), which was charged to find and implement Medicare savings, but was never triggered
   2. ACOs: The budget legislation establishes the ACO Beneficiary Incentive Program, which would allow accountable care organizations to pay patients if they make primary-care appointments.
   3. Medicare: The agreement included the CHRONIC Care Act of 2017 which aims to streamline care coordination, improve disease management, and reduce Medicare costs. The bill reauthorized D-SNP programs, approved telemedicine coverage for MA plans and ACO’s.
   4. Short Term Health Plans: The new coverage rules allow consumers to buy less expensive health insurance options, including short-term, limited duration insurance.

Source: Modern Healthcare

2. Recognizing the scarcity of available physician assets, health systems are building their own medical schools to ensure a pipeline of new doctors:
   1. Prime Healthcare committed $60M toward a newly accredited medical school – California University of Science and Medicine. (Source)
   2. Hackensack Meridian announced its New Jersey based medical school received preliminary accreditation.
   3. Kaiser announced plans to open a medical school in the fall of 2019
   4. Previously, Geisinger Health System acquired Commonwealth Medical College in 2016

Sources: Modern Healthcare, Eastside Health Network

3. Health Systems continue to merge to form multi-regional chains:
   1. Atrium Health, previously Carolinas HealthCare System, and Navicent Health signed a LOI to merge, giving Atrium Health a regional presence in Georgia.
   2. Mercy Health and Bon Secours merge to form a 43-hospital organization across 7 states with $8B in net operating revenue.

4. Are Google and Apple tipping their hands?
   1. After reportedly choosing not to acquire Crossover Health, Apple opts instead to build its own employee healthcare clinics, AC Wellness. No word on larger designs to remodel their iconic Apple Stores with adjacent exam rooms for combined Wellness Visit/Genius Bar appointments (Source)
   2. Google’s healthcare venture division, Verily, posts position for a senior Health Plan Executive -- triggering inevitable rumors of Google targeting the Health Plan or Population Health spaces (Source)

PROVIDER SPOTLIGHT

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

Evolent Partner News

1. ​On March 14, hospital-run Managed Medicaid plan Passport Health Plan breaks ground on a 20-acre campus in West Louisville, Kentucky, a city whose economic inequality and social segregation are among the highest in the nation. Passport’s goal: build a campus that breaks poor-health cycles by addressing social determinants of health. The 20-year-old organization has a long history that demonstrates how Medicaid can be resilient in the face of political change, and its new initiatives show how hospital-run Medicaid plans can be a model for the nation. Passport will move 500 employees to its new health and wellness campus, with plans for a farmer’s market to address the food desert, job training programs, and more. Watch for the case study by Passport CEO Mark Carter and Evolent Medicaid President Mike Minor in the April edition of hfm Magazine.
2. Evolent added four new provider partners to the Next Generation Accountable Care Organization (ACO) program for the 2018 performance year. Evolent now supports a total of 10 provider partners across the three Next Generation ACO cohorts—one of the nation’s largest groups of Next Gen ACOs operating on a shared infrastructure. New Evolent partners participating in the final Next Gen cohort include: CoxHealth, Franciscan Missionaries of Our Lady Health System Health Leaders Network, South Shore Health System and St. Joseph’s Health.

General Updates

1. Six New Jersey hospitals form the Healthcare Transformation Consortium in an effort to pool resources to reduce administrative costs associated with managing their self-funded employee health plans. Participant health systems include Atlantic Health, Centra State, Holy Name, Hunterdone, St. Joseph’s and Saint Peters.
2. Eastside Health Network announces the launch of four value-based contracts which will offer nearly 20,000 patients access to ACOs
3. Prime Healthcare California University of Science and Medicine’s medical school receives preliminary accreditation—funded in large part by Prime Healthcare Foundation.
4. Caravan Health and Astria Health partner to create the Astria Health Clinically Integrated Network.

GOVERNMENT, REGULATORY & INDUSTRY PULSE

1. On March 5, Alex Azar shared his remarks on value-based transformation to the Federation of American Hospitals. Evolent is encouraged by his indication that the federal government will be taking a big-picture look at value-based care and the opportunities that offers for providers thinking strategically about population health initiatives. Some excerpts from Azar are below:
   1. Innovation in payment and delivery systems has been lackluster. The shift to a value-based payment system “needs to accelerate dramatically.”
   2. It’s not an option to turn back to a system that “pays for procedures rather than value.” This administration is “unafraid of disrupting existing arrangement simply because they’re backed by powerful special interests.”
   3. The consumer should control their own health records. In fact, “we already have the technological means to offer this power to patients, but it hasn’t yet happened.”
   4. Doctors, hospitals, drug companies and pharmacies should “become more transparent about pricing and outcomes of their services and products.”
   5. “Results for the early stages of federal efforts to encourage accountable care organizations have been underwhelming,” largely because providers weren’t given the opportunity to experiment with taking on risk. 
   6. In terms of Medicare and Medicaid, the focus is to reorient “how these programs pay for care and create a true competitive playing field where value is rewarded handsomely.”

CMS

1. CMS approves Indiana’s Medicaid waiver which continues the work of the state’s Medicaid expansion program called Healthy Indiana 2.0 Plan. The new waiver requires all able-bodied to work at least 20 hours per week, be enrolled full-time or part-time in school, and pay premium contributions.

Federal

1. Congress’ budget deal includes changes to the MSSP and established the ACO Beneficiary Incentive Program, which would allow ACOs to pay patients if they make primary-care appointment. The deal will also allow beneficiaries to assign a physician in an ACO as their PCP.

EVOLENT IN THE NEWS

Follow our Knowledge Center for additional insights.

1. Shantanu Phatakwala, Evolent Health’s Managing Director of R&D, penned an article featured in HFMA on the use of predictive analytics to identify high-risk patients and achieve population health.
2. Evolent Vice President Chris Dawe discusses with Modern Healthcare the appeal of ACOs for independent physicians, and the outlook for risk-based ACOs.
3. Ken Wood, Evolent Senior Vice President of Health Plan Development, talks potential budget impacts on telehealth with Bloomberg.

STUDIES SHOW

1. Most physicians do not believe that value-based payments models are effective solutions for quality improvement and cost control, according to a new survey from Leavitt Partners. 22% of the doctors surveyed thought ACOs could lower spending. This may be due to lack of physician engagement in developing and adopting these models.
2. Healthcare companies are focusing more on patient-centered care models, but very few are incorporating patient voice into their strategies, according to a recent report from the Health Care transformation Task Force.
3. JAMA Internal Medicine publishes study showing “the uptake of rideshare-based transportation is low and is not associated with a reduction in missed primary care appointments” for Medicaid patients.
4. The Hidden Roles that Management Partners Play in ACOs—“37% of ACOs reported having a management partner, and two-thirds of these ACOs report that the partner shared in the financial risk or rewards.”
5. 80% of payers believe that addressing social determinants of health for their members is important to improve their pop health programs, according to a new Change Healthcare Survey. 35% of payers are integrating socioeconomic data with clinical data and 42% are incorporating community resources into their pop health programs.
6. Chronic care management program shows signs of saving money and improving quality—“over the second year of the experiment, the CMS paid roughly $52M in CCM fees and generated a net savings of $36M, largely because those beneficiaries were less reliant on both inpatient and outpatient care.”

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