Value-Based Care Intelligence Digest - December 2018

Every month, Evolent Health rounds up some of the latest value-based care news from the previous month spanning policy, research, innovations, payers and providers. 

Top Trending Topics

1. Rumors are swirling that Humana and Walgreens might turn up the heat on their relationship by taking equity stakes in each other.
   • The companies are three months into a partnership in which Partners in Primary Care, a Humana subsidiary, operates senior-focused primary care clinics inside two Walgreens stores in the Kansas City area. The companies are looking at expanding this partnership, the The Wall Street Journal reported.
   • The news comes amid the closing of the $69 billion CVS-Aetna deal. For Walgreens, an expanded relationship with Humana could have similar benefits to the CVS-Aetna deal at a lower cost than a full acquisition.
2. Big tech companies continue to hire health care industry veterans to help them decipher the industry.
   • Google hired Geisinger Health CEO David Feinberg to define a strategy for its moves into health care. 
   • Lyft hired Megan Callahan, who was most recently chief strategy officer at Change Healthcare, as its first vice president of health care.
   • The moves follow the announcement this summer that Atul Gawande—a surgeon at Brigham and Women's Hospital, professor at Harvard's T.H. Chan School of Public Health, staff writer at The New Yorker, and bestselling author—would be leading the health care venture formed by Amazon, JP Morgan and Berkshire Hathaway.
3. Everyone wants to be a provider.
   • On the heels of its merger with Aetna, CVS will add health services to its stores early next year. It plans to extend primary care at its MinuteClinics around chronic disease management, combine Aetna clinical programs to help patients during and after discharge, and provide complex disease management.
   • Beacon Health Options is launching Beacon Care Services, which will provide outpatient mental health therapy for treatment of common issues such as depression, anxiety and stress. Its first location will be in a Texas Walmart store.
   • UnitedHealth Group is acquiring The Polyclinic, a 210-physician practice that is one of the largest multispecialty physician groups in the Seattle area
   • Cerner is opening a new care center for members of Plumbers Local Union 130 United Association and their families in southwest Chicago. Cerner currently operates several health centers for its employees and other unions.

Industry Spotlight

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

1. Banner Health inaugurated a new physician protocol to increase screenings for an often-misdiagnosed upper-respiratory infection known as valley fever. Two-thirds of the nation's cases occur in Arizona, where doctors trained out of state don't always know to look for it and can misdiagnose it as pneumonia. Earlier detection could prevent unneeded treatments and biopsies and reduce the number of deaths that occur due to the disease.
2. Cox Health has launched virtual visits to connect patients to care providers electronically. Patients log in and are connected by a patient care navigator to an appropriate care provider, who can make diagnoses and write e-prescriptions via video. Cox Health aspires to both ease access for those with limited transportation options, and to help contagious people stay home rather than spreading conditions such as the flu.
3. A program to reduce C-sections at South Shore Health System got national attention from NPR, which noted that in the first four months of using the Team Birth approach developed by Atul Gawande’s Ariadne Labs, South Shore’s primary, low-risk C-section rate dropped from 31 percent to 27 percent—about four fewer C-sections each month.
4. An AI-focused kidney disease and transplant management start-up affiliated with Mount Sinai Health System raised $29 million in an initial public offering. Part of the proceeds from the stock sale for the company will be used to complete a multi-center clinical study to validate an early detection protocol for patients who have Type 2 diabetes or who are of African ancestry. Approximately 1 million of Mount Sinai’s patients are either diagnosed with Type 2 diabetes or are of African ancestry, which are two of the major at-risk population segments for kidney disease.

Government, Regulatory & Industry Pulse

Federal

1. HHS Secretary Alex Azar shared in early November that CMS plans to propose a mandatory Medicare payment model focused on radiation oncology for cancer patients, and two new voluntary models for cardiac care. Oncologists want CMS to make participation voluntary for the early years of the oncology model. HHS first revealed the need for a radiation oncology model in a report to Congress last year, which revealed that Medicare Part B payments for radiation treatment increased 216 percent between 2000 to 2010.
2. Speaking at an event focused on addressing the social determinants of health, Azar suggested that CMMI may soon begin to test approaches that allow health care organizations to use Medicaid funding to pay for the housing needs of low-income patients. Azar highlighted several key initiatives already underway at CMMI to better integrate health care financing with social care services such as housing, nutrition, addiction treatment and mental health support.

States

1. Wisconsin obtained approval from the Trump administration to impose work requirements on Medicaid beneficiaries. Wisconsin did not expand Medicaid, and the approval marks the first time a non-expansion state has been given permission to impose work requirements. Under the new rules, Wisconsin Medicaid recipients will be required to work at least 80 hours a month to maintain eligibility. If they fail to do so for 48 aggregate months, they will lose coverage for six months. The state also received permission to charge beneficiaries premiums—up to $8 per month—and to lock people out of coverage if they fail to pay. In a statement, CMS Administrator Seema Verma said the administration will continue letting states impose work requirements.

Evolent in the News

1. Low patient health literacy has shown to lead to higher rates of hospitalizations and emergency room visits, poorer chronic disease management and higher health care costs. According to the National Institutes of Health, the cost of low health literacy is only growing. Dr. Andrew Snyder, Evolent’s chief medical officer, spoke with Modern Healthcare about  how hospitals can work to address this problem and help improve patient outcomes.
2. In this Modern Healthcare story, Evolent Chief Innovation Officer Anita Cattrell shares her thoughts on Azar’s announcement that Medicaid may soon allow hospitals and health systems to directly pay for housing, healthy food or other solutions for the "whole person."
3. In his experience working with leading providers in New York, California and other states, Snyder has learned many lessons about physician reimbursement. Read this STAT First Opinion article to find out what he thinks are the top six ways to smooth the journey to value-based care and change how primary care physicians get paid.  
4. How can health care organizations effectively address social determinants of health issues?  Snyder and Cattrell explain how health systems can be thoughtful and targeted when investing in social determinants in this piece.  

Survey Says/Studies Show

1. Over the past year, insurers have been on a provider buying spree. UnitedHealth Group, Humana, Centene and Anthem have announced deals to acquire primary care practices, hospice providers and home health care companies. Last year, the number of mergers and acquisitions in health care totaled 967, with a combined value of $175.2 billion, according to a report from PwC’s Deals practice.
2. In half of U.S. states, commercial health insurance markets were less competitive in 2017 than the prior year, the American Medical Association reported. In 91 percent of 380 metropolitan areas studied in 2017, at least one insurer had a commercial market share of 30 percent or more of the market. In nearly half (46 percent) of metropolitan areas, a single insurer’s market share was at least 50 percent. Overall, 73 percent of metropolitan areas had a significant absence of health insurer competition and were considered "highly concentrated" based on federal guidelines used to assess market competition.

Read the Full Article