Value-Based Care Intelligence Digest - May 2018

May 10, 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. Humana had a busy month:
    1. Humana and its private equity partners made moves to create the country’s largest hospice operator through its acquisition of Curo Health Services for $1.4 billion. Humana, TPG Capital and Welsh, Carson, Anderson & Stowe acquired Kindred Health at the end of 2017 for $810 million. Humana also continues to acquire primary care providers, adding Family Physician Group (FPG), which serves Medicare Advantage and Managed Medicaid patients in greater Orlando.
    2. Humana and Landmark announced a home-based medical, behavioral and palliative care coordination program for Humana’s Medicare Advantage members.
    3. Humana also enhanced its specialty-care payment models with a new value-based care maternity bundled payment model and an expanded hip and knee replacement bundle model for its Medicare Advantage population in seven additional states.
  1. Payers and providers shored up Home Health services and capabilities, and policy-makers saw results from home and community-based services:
    1. CMS extended its Independence at Home (IAH) demonstration pilot an additional two years after significant savings in the first two years of the program.
    2. Florida Blue announced a partnership with PopHealthCare to deliver in-home patient care services for Medicare Advantage members who have had recent stays in hospitals or who have complex chronic medical conditions.
    3. CVS Health will offer home-based dialysis for kidney failure patients through its Coram business.
  1. Start-up health plans continue to shine:
    1. Bright Health grew to 12,000 members in Colorado in its first year with a medical loss ratio of 87%. Bright’s revenues from premiums totaled $36 million in 2017 and are expected to jump to up to $150 million by the end of the year.  
    2. Oscar raised $165 million in its latest round of funding, at a valuation of $3.2 billion. The funding will be used to secure collaborations similar to its Cleveland Clinic and Humana partnership.

PROVIDER SPOTLIGHT

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

Evolent Partner News

  1. Leaders from Evolent Health and Passport Health Plan explain how innovation from within a centralized Medicaid Center of Excellence can have impacts both nationwide and at the local level.

General Updates

  1. OptumCare will focus on consumer-centric care and risk-based contracting and aims to serve 75 markets in the U.S., according to OptumHealth CEO Andrew Hayek.
  2. University of Pennsylvania Health System, Mercy Health System and St. Mary Medical Center formed a partnership to bolster joint clinical care programs, including cancer, cardiology and surgical services, in the Philadelphia area.
  3. Adventist Health and St. Joseph Health will integrate their Northern California clinical operations through a new joint operating company.

GOVERNMENT, REGULATORY AND INDUSTRY PULSE

CMS

  1. CMS will give Medicare Advantage plans a 3.4% pay hike in 2019, higher than the 2.95% increase for 2018. The CMS final rule also outlines increased use of encounter data to determine risk scores for plans.
  2. CMS expanded its definition of “primary health-related” benefits that insurers are allowed to include in their Medicare Advantage policies. These new benefits could include air conditioners for people with asthma, healthy groceries, rides to medical appointments and home-delivered meals.
  3. CMMI’s Independence at Home (IAH) demonstration showed significant savings for Medicare. The program saved an average of $2,700 per beneficiary per year in the first two years and has been extended for another two years.
  4. CMS proposed a $1 billion raise for post-acute care providers (skilled nursing facilities, hospices, inpatient psychiatric and rehab facilities), along with several policy changes to reduce burden on them as well as the patients that use those facilities.
  5. CMS announced changes to empower patients through better access to hospital price information, improve patients’ access to electronic health records, and make it easier for providers to spend time with their patients.

Federal

  1. Dr. Ronny Jackson, Trump’s nominee for VA Secretary, bowed out of the nomination after several allegations emerged regarding irresponsible prescribing practices.
  2. Ascension’s President and CEO, Anthony Tersigni, is on the short list of names for a new VA secretary nominee.

EVOLENT IN THE NEWS

Follow our Knowledge Center for additional insights.

  1. Jesse James, Evolent Clinical Medical Information Officer, discusses with Modern Healthcare the impact of the recent CMS announcement to give the Meaningful Use program a makeover.
  2. Houston Methodist’s, Dr. Julia Andrieni, and Evolent Health’s Vice President of Clinical Transformation, Dr. Michael Udwin, share their learnings about best practices to reduce physician burnout. Stay tuned for the published case study coming next month in Medical Economics.  

STUDIES SHOW

Medicare / Medicaid:

  1. According to recent Axios analysis, more than 3 million people are enrolled in a provider-sponsored Medicare Advantage plan.
  2. According to a new study by Health Affairs, meal delivery programs reduce the use of costly health care and decrease spending in dually eligible Medicare and Medicaid beneficiaries.

Population Health Management:

  1. Population health strategies that improve access to health care and address social determinants of health may reduce the use of costly emergency services and inpatient hospitalizations, according to a new study published by Health Affairs about Baylor Scott and White.

Value-Based Care:

  1. In 2016, the U.S. spent almost two times as much on health care, and performed worse, than 10 high-income countries. Price of labor, pharmaceuticals, devices and administrative costs are the main drivers of the difference in health care spending, according to a new JAMA study. 
  2. Value-based care is driving up salaries for medical group and hospital CEO and COOs, according to a survey from American Medical Group Association.

General:

  1. According to a new HealthEdge study, member satisfaction is the most important goal for 2018 among health insurers, followed by lower costs, improved provider relationships, increased membership, regulatory compliance, and, lastly, a shift to value-based models.
  2. Venture Capital firm Venrock’s annual report on health care industry innovation and investment shows that health care leaders find value in innovative platforms to address complex needs rather than one-off solutions / apps with a smaller reach. 
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