Value-Based Care Intelligence Digest - August 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. Amazon acquires PillPack, furthering its move into health care
   1. Amazon, Inc. announced its $1 billion acquisition of PillPack, an online pharmacy startup, giving it a platform to launch a nationwide pharmacy.
   2. After the acquisition announcement, shares of major pharmacy companies took a big hit. CVS, Walgreens and RiteAid collectively lost $11 billion in value, and Walmart, which previously made a $700 million bid for PillPack, was down $3 billion.
   3. The acquisition news comes after last month’s announcement that Dr. Atul Gawande was selected to head the Amazon/Berkshire Hathaway/J.P. Morgan health care company.
2. Insurers are investing in social determinants of health to help lower health care costs
   1. A lot of news this month was centered around how health insurers and providers are investing in social determinants of health (e.g., availability of resources to meet daily needs, access to education and job opportunities, environmental and physical hazards) to help lower health care costs.
   2. Intermountain Healthcare and Kaiser Permanente are both partnering with government agencies and community organizations to invest millions ($12 million and $200 million, respectively) in pilot projects that support nonmedical factors like housing and food insecurity.
   3. The CEO of WellCare Health Plans recently brought attention to how the insurer’s work over the last seven years to connect members to social services like food, medication assistance and transportation has led to a 26 percent decrease in emergency spending.
   4. For more on determining the “impactability” of both social and clinical initiatives, download Evolent Chief Innovation Officer Anita Cattrell’s guide, “Why Your Population Health Results Vary: How Systems Are Cracking The Code On Finding The Right Patients.”

Provider Spotlight

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

Evolent Partner News

1. Partners from across the nation share their unique experiences working with Evolent and how they are accelerating impact in their communities.
   
2. John Chomeau, Chief Population Health Officer at a leading health system in Florida, shares his perspective on how working with Evolent accelerated new opportunities in value-based Medicare and Medicaid.
3. Dr. Martin Hickey, New Mexico Health Connections founder, speaks with NPR’s Michel Martin and Wall Street Journal reporter Anna Mathews about the suspension of billions of dollars in payments to encourage insurers to participate in the Affordable Care Act.
4. Dr. Martin Hickey also shared his thoughts with the New York Times about the freeze on payments to insurers and how nontraditional payers like hospital-sponsored plans are affected by such actions.

General Updates

1. Highmark's value-based payment program saved the insurer more than $260 million within its first year, continuing an industry trend. The nonprofit insurer announced that its payment arrangement program for primary care physicians reduced hospital readmissions by 16 percent last year, which potentially saved $224 million. Additionally, an increased focus on prevention and wellness, including screenings and vaccinations, helped save an estimated $38 million in avoidable emergency room visits.
2. The publicly operated L.A. Care Health Plan will commit $31 million to recruit doctors, putting money toward overcoming the financial hurdles that keep physicians from choosing smaller clinics over larger health systems. CEO John Baackes said the funding will come from the company's reserves and go toward three grant programs including medical school scholarships, medical school loan repayments and a program to help with physician salary subsidies, sign-on bonuses and relocation costs.
3. WelbeHealth, a health care services company delivering coordinated and value-based care to medically frail seniors, announced that it raised a $15 million Series B financing. The financing was co-led by Longitude Capital and Ulysses Diversified Holdings (Ulysses) with participation from former Medicare Chief Andy Slavitt’s Town Hall Ventures, as well as existing investors F-Prime Capital and .406 Ventures. The proceeds from the financing will be used to support the launch of WelbeHealth’s Programs of All-Inclusive Care for the Elderly (PACE). WelbeHealth is also home to three Evolent alumni – Richard Gurley, Ethan Epstein and Shelley Newhouse.
4. Intermountain Healthcare is spearheading a new alliance with a focus on the social determinants of health. The Utah Alliance for the Determinants of Health will be led by the health system in Ogden and St. George, Utah. Intermountain projects that the investment in better efficiency and coordination will lead to lower-cost care. Intermountain is one of many health systems making significant investments in addressing the social determinants of health; Kaiser Permanente announced in May that it would invest $200 million in housing initiatives in partnership with Mayors and CEOs for U.S. Housing Investment.
5. Anthem members will be able to access medical advice through a mobile telehealth app on their Samsung phone thanks to a new three-way partnership with the technology giant and American Well. The collaboration will provide access to American Well physicians through an updated Samsung Health app that now offers access to LiveHealth Online. The new partnership streamlines several existing contracts between the three companies. The addition of Anthem, which operates Blue Cross Blue Shield plans in 14 states, opens the service up to 74 million members.
6. Rutland Regional Medical Center is in the early stages of becoming an ACO, although the change is not expected to be pursued until next year. CEO Claudio Fort believes Rutland Regional is "fairly well positioned" to create an ACO with area health care providers. Fort says the hospital is considering partnerships with Vermont Mental Health, the Visiting Nurses Association and Hospice of the Southwest Region.
7. Health insurers are striving to influence members' social determinants of health, and some have already seen costs decline as a result. Insurers are covering transportation to and from grocery stores, offering vouchers to buy fresh produce, partnering with food banks and covering telehealth services to improve patient health and access to care. In a recent U.S. News op-ed, the CEO of WellCare Health Plans describes the insurer’s work over the last seven years to connect members in need with access to social services including food, medication assistance and transportation. WellCare has found that providing these services has led to a 26 percent decrease in emergency spending. UnitedHealthcare is awarding $1.95 million in grants to local organizations that are expanding services to address some of Wisconsin’s key social determinants of health, such as food security.

Government, Regulatory & Industry Pulse

CMS

1. The American Hospital Association came out in strong opposition to CMS’s proposal to make interoperability a condition of receiving payment from Medicare and Medicaid. The proposed 2019 Inpatient Prospective Payment System (IPPS) rule would set electronic sharing of data with other providers and patients as a requirement for participation in the programs. Meanwhile, a coalition of ACOs, health information exchanges (HIEs) and other organizations submitted a comment letter praising the aggressive requirements for interoperability.
2. CMS has proposed a value-based payment system for home health care services and is considering paying home health agencies for remote patient monitoring using digital health tools to collect vital signs, heart rate and other health data. The agency said the proposed changes would increase Medicare payments to home health agencies by $400 million next year. Congress has mandated that Medicare shift to value over volume by stopping the use of number of therapy visits provided by home health agencies to determine payment.
3. CMS released the 2019 proposed Physician Fee Schedule. In this rule, CMS now proposes to cover telemedicine and telephone visits for brief check-ins, evaluation of patient-submitted images or remote monitoring data, as well as more comprehensive and preventive care visits. Should this move forward, it will be a substantial step toward increasing access for the two-thirds of Medicare beneficiaries who are ineligible for telemedicine coverage. Today, CMS only pays for telemedicine services when provided to rural patients, through downside-risk ACOs or Medicare Advantage plans.

Federal

1. The Department of Health and Human Services (HHS) is considering changes to the Anti-Kickback Statute with plans to release a request for information (RFI), Deputy Secretary Eric Hargan told lawmakers. Last month, CMS issued a request for information seeking public input on how to reduce the burden of the Stark Law, which has created obstacles to value-based care.
2. Senate hearings for Brett Kavanaugh, President Trump’s pick to replace Supreme Court Justice Anthony Kennedy, are likely to begin in September. With few exceptions, his work has been consistent with conservative judicial thinking. The prospect of another reliable conservative on the court may accelerate the movement of several key health care cases through the judicial system, enhancing Republican efforts to dismantle key elements of the Affordable Care Act (ACA).

States

1. Rhode Island officials have requested an extension of a 1115 demonstration from CMS to expand the use of value-based care within the state’s Medicaid program. State Medicaid administrators are looking to add new value-based care provisions to their Health System Transformation Project, including new provider accountability measures for costs and outcomes, programs to help transition elderly from hospital settings to community-based care and re-engineered managed care contracts that support accountable care. Since 2015, Rhode Island’s Medicaid program has used the 1115 demonstration program to reduce costs and improve outcomes for the state’s 300,000 beneficiaries, which has helped save the state $100 million in Medicaid costs.
2. Arkansas, Indiana and New Hampshire will push forward with Medicaid work requirements despite a recent court ruling that blocked Kentucky from implementing such requirements in its program. Implementation of Medicaid work provisions is scheduled for this summer in Arkansas, while New Hampshire and Indiana intend to phase in rules at the start of 2019. Virginia lawmakers approved Medicaid expansion in June with the condition the state apply for federal permission to include a work requirement. Despite the news from Kentucky, Virginia health officials say they still plan to seek federal permission to enact a work requirement.

Evolent in the News

Follow our Knowledge Center for additional insights.

1. Iris Sheu, Senior Analyst at Evolent, discusses the role of population health in dealing with opioid crisis. Read the full article in the July edition of Population Health News (subscription required).
2. Molly Menton, Director of Clinical Delivery at Evolent, provides valuable insights about the future of technology in the health care space. Read how the industry can get high-tech to remain high-touch in this HealthTech Magazine article.
3. In case you missed it: “Evolution of Health Care: Bridging the Clinical, Administrative and Financial,” by Evolent’s Frazer Buntin and Kate Rollins, has been published by several Healthcare Financial Management Association chapters.

Survey Says / Studies Show

1. Altarum Institute released a report that said spending on the privately insured accelerated compared to those covered by Medicaid and Medicare in the last year and a half, despite low growth in enrollment in private insurance. Private payer spending per enrollee has grown at three times the rate of Medicare and Medicaid spending per enrollee at 45.9 percent growth compared to 14.7 percent and 14.9 percent, respectively. Spending on Medicare and adult Medicaid enrollees is still higher than spending per enrollee in private health plans. Still, this is a shift from just a few years ago, when private spending growth was either near or below Medicare and Medicaid rates, the authors said. They also noted that a contributing factor may be the disparity in public and private prices paid for by health services within the U.S., with many providers subsidizing lower Medicare and Medicaid prices with higher prices for patients with private insurance.
2. Despite higher rates of social and economic risk factors, Medicare Advantage beneficiaries experience 23 percent fewer inpatient stays and 33 percent fewer ER visits than the fee-for-service (FFS) population, according to a new analysis by Avalere that compared service utilization and health outcomes between MA and FFS beneficiaries. This trend extended to the dual-eligible subsets of each Medicare population as well. Like MA patients overall, dual-eligibles in MA see fewer complications and avoidable hospitalizations than those in FFS, but they also spend more on preventive services, including LDL tests used to measure cholesterol (82 percent vs. 69 percent) and breast cancer screens (73 percent vs. 50 percent).

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