Value-Based Care News Digest - August 2019

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 Themes

1. CVS Health accelerates its efforts "to create a new health care model that is easier and simpler to use," despite delays in the federal courts with its Aetna acquisition.

• The company is beginning human trials of a new at-home dialysis machine, news that comes on the heels of President Trump's executive order that aims to improve Americans’ kidney health. If the device proves effective at making dialysis easier and safer to do at home, CVS could threaten the two companies that dominate the market for outpatient dialysis clinics, which most users visit three times a week. The device was designed by a firm founded by Dean Kamen, the inventor of the two-wheeled Segway personal transporter.

• MinuteClinic has rolled out its virtual-visit offering to eight additional states: Arkansas, Connecticut, Hawaii, Indiana, Minnesota, Missouri, Oklahoma and Texas. The additions make for 26 states where individuals can access MinuteClinic video visits 24/7 from their mobile device or computer.
• In May, CVS announced that it will launch 1,500 HealthHUBs in its stores by the end of 2021, and CEO Larry Merlo recently told investors that the HealthHUBs are outperforming traditional stores. "We are seeing additional traffic and seeing that translate to sales momentum" throughout the store, including the "front end" and in the CVS MinuteClinics, Merlo said. The HealthHUBs dedicate more than 20% of the store space to health services.

2. Under pressure: Executive changes at regional payers raise questions about the squeeze the regionals are feeling amid industry changes.

• Top executives at Health Care Service Corp. (HCSC) CEO Paula Steiner and CFO Eric Feldstein, announced their resignations this month. Shortly after the announcements, some news outlets pointed to disagreements over Steiner's growth strategy for the insurer as the reason for her departure, stating the board felt the payer needed to be more aggressive given industry consolidation. Current board member David Lesar will fill in as interim CEO, while Maurice Smith, formerly president of HCSC's Illinois health plan, will serve as president.
• How aggressive should regional payers be in this time of change? Many regionals, including HCSC, are moving into care delivery, yet questions remain whether it will be enough to combat the scale and care-delivery efforts from national payers and continued health system consolidation.

3. Meanwhile, start-up insurers continue to expand into new markets with their narrow network plans.

• Oscar will offer Medicare Advantage plans in New York and Houston this fall. Pending approval by CMS, residents in either state can begin enrolling in the plans in October.
  • New York: Oscar will partner with Montefiore Health System to launch a co-branded Medicare Advantage product.
  • Texas: Oscar will partner with HCA Houston Healthcare, Houston Methodist, Village Family Practice/VillageMD, St. Joseph Medical Center, IntegraNet and Privia Medical Group-Gulf Coast for its Medicare Advantage plans.
• Bright Health will begin offering health plans in 13 new markets across seven states—Florida, Illinois, North Carolina, Ohio, Oklahoma, South Carolina, Nebraska—in 2020, plus expanded product offerings in every existing market. This expansion will bring Bright's footprint to a total of 22 markets in 12 states.

Industry News

General News

• Care1st Health Plan Arizona is the first Medicaid plan in the country to offer bundled payments as part of a value-based agreement for hepatitis C treatment. In the Care1st program, the full bundled payment is dependent on a cure, defined by full virus eradication, which makes providers directly responsible for managing medication adherence. The yearlong bundled payments initiative will involve a partnership with Maricopa Integrated Health System (MIHS) hepatologists at the Maricopa Medical Center, and it will involve 100 patients with hepatitis C, who will be given antiviral medications. After the medication is administered over 8 to 12 weeks, follow-ups will ensure medication adherence and successful treatments. The patients will then continue to be followed at Care1st's Hepatitis C Center of Excellence. Following results after one year, Care1st will decide whether to continue and/or expand the program.
• Houston Methodist Sugar Land Hospital reported $717,000 in attributable cost savings and an average incremental cost reduction of $105 per admission after implementing technology that brings cost and risk data to the point of care. Smart Ribbon, developed by IT start-up IllumiCare of Birmingham, Ala., enables the data to automatically appear and hover over clinicians’ screens as they work in patient’s electronic charts.
• Blue Cross and Blue Shield of Oklahoma (BCBSOK) and Integris Health, Oklahoma’s largest payer and health system respectively, announced a five-year contract to focus on initiatives that will help Oklahoma become a top 10 state in overall health. Currently, the state ranks 47 out of 50 in overall health. The organizations have agreed to jointly develop new value-based care capabilities, and they will work with state officials, health agencies, businesses, communities and others on initiatives to achieve the goal.

Primary Care

• Humana and Walgreens Boots Alliance are expanding their joint venture for senior health clinics to more locations. Three additional Partners in Primary Care centers will open inside Walgreens stores: two in the Kansas City area and another in Anderson, South Carolina. The two companies have had a pilot underway in two Kansas City-area sites for about a year.
• Premera Blue Cross and Vera Whole Health announced they are collaborating to open two advanced primary care centers in Spokane, Wash. for Premera members. When fully operational, each care center will employ up to 40 people, including doctors, nurses, behavioral health professionals, health coaches, medical assistants, administrative staff and radiology technicians.
• Advocate Aurora Health and One Medical are partnering to expand membership-based primary care in the Chicago-land area. Advocate Aurora will be the preferred chain for One Medical's three existing Chicago clinics and any future locations the organizations open together. Doctors at the new co-branded clinics will refer members to Advocate Aurora specialists when appropriate, but patients will still have the option to seek care elsewhere. The organizations are also in the process of identifying Chicago-area markets to open new membership-based clinics. In January, Advocate Aurora announced a deal with Oak Street Health to open a primary care clinic for seniors in Elgin, a northwest Chicago suburb.
• L.A. Care Health Plan is tackling California's primary-care physician shortage by committing more than $5.2 million to establish 14 new residency positions at five medical facilities. Some of the funding will also go to new faculty positions. A recent report found that California faces a shortage of 8,800 primary care physicians by 2030. The $5.2 million in funding is part of the plan’s $31 million "Elevating the Safety Net" initiatives, which launched last year with three initial programs: a physician recruitment program, a physician loan repayment program and a medical school scholarship program. Since the launch, 72 recruitment grants have been awarded, 48 new physicians have already been hired, and 18 physicians have received loan repayment grants. L.A. Care, the nation's largest publicly operated health plan, planned to seek board approval for an additional $31 million for the initiative.

Maternal Health

• The Health Care Transformation Task Force (HCTTF), a nonprofit industry consortium of which Evolent Health is a member, released a new report about using value-based care models to drive positive outcomes and reduce disparities about maternal health. While maternal mortality rates have fallen across the globe, the U.S. has gone in the opposite direction: Maternal mortality and pregnancy-related deaths have increased 139% since 1987, HCTTF writes in the Health Affairs Blog.

Behavioral Health

• WellCare and AbleTo, a provider of virtual behavioral health care, announced the launch of a new program to serve WellCare's Medicare Advantage members in New York. AbleTo analyzes health data and identifies members who would benefit from treatment, and then delivers that care virtually or over the telephone through a nationwide network of skilled professionals. Members work with a therapist and coach for up to eight weeks of personalized care. AbleTo virtual behavioral health care services are available to all WellCare Medicare Advantage members in the state of New York.

Social Determinants of Health

• CVS Health announced it will collaborate with social care coordinator platform provider Unite Us to launch a platform that will allow Medicaid and dual-eligible beneficiaries covered through Aetna to more easily find and access help from social care providers within their communities. The programs and services will initially be available to Aetna Medicaid members in Louisville, Ky. and for Aetna's dual-eligible special needs members in Tampa, Fla. and southeastern Louisiana, beginning later this year.

Telemedicine

• Telemedicine startup Call9, which had raised $40 million in equity and debt financing since its founding in 2015, is shutting down and laying off its remaining 100 workers after peaking with a staff of about 200. Its business model was to embed care providers, such as paramedics, at nursing homes so they could respond to emergencies. When a patient needed help, the paramedics could use Call9's software to connect by video-chat with a remote emergency-medicine physician. The doctor could then determine whether a patient needed to go to the hospital.

Evolent Partner News

• Anthem Blue Cross has partnered with CareMore Health and River City Medical Group (RCMG), an Evolent partner, to introduce a new model of care to deliver comprehensive, home-based services for Anthem Medi-Cal consumers in the Sacramento, Calif. area. The CareMore home-based program identifies RCMG patients who are chronically ill and have complex health needs to be treated by CareMore health care professionals. These members can access a full range of services, such as physical and mental health care, as well as social service supports that are delivered in the individuals’ homes. RCMG is the first Anthem Blue Cross care provider to participate in the CareMore home-based program and has contributed insight to help design and launch the program. RCMG is one of Northern California's largest independent physician associations, with approximately 1,600 network physicians and 600 provider and clinic locations that serve more than 250,000 Medi-Cal beneficiaries, including 150,000 Anthem Blue Cross consumers.

Government and Regulatory Pulse

CMS

• President Trump signed an executive order to launch Advancing American Kidney Health, an initiative to deliver on three goals: fewer patients developing kidney failure, fewer Americans receiving dialysis in dialysis centers, and more kidneys available for transplant. The executive order will create new payment models to encourage more kidney transplants and give incentives to seek dialysis treatment at home instead of at more expensive treatment centers. Under the order, the administration says it will also streamline and expedite the process of kidney matching in order to help increase transplants. About 30 million U.S. adults are estimated to have chronic kidney disease and most are not diagnosed. Treating the disease costs Medicare more than $110 billion a year.
• CMS is proposing to launch a radiation oncology model that would make prospective payments to cover radiotherapy services, in 90-day episodes, for patients diagnosed with 17 types of cancer. The model would link payment to quality metrics and would require participation in randomly selected geographic areas. It would also qualify as an Advanced Alternative Payment Model (APM) and Merit-based Incentive Payment System (MIPS) APM under the Quality Payment Program (QPP).
• Adam Boehler, HHS deputy administrator and director of CMS' Center for Medicare and Medicaid Innovation, has been nominated for another federal position and will be leaving CMMI. For the past year, Boehler has been CMMI director and led the launch of several value-based payment models. Prior to HHS, Boehler founded home health company Landmark Health, which assumed risk for its more than 80,000 patients, and he also founded Avalon Healthcare Solutions, a laboratory benefit services company. President Trump selected Boehler to be CEO of the U.S. International Development Finance Corp., a recently formed agency that will oversee the finances of projects in foreign countries.

Survey Says/Studies Show

• HHS' Office of Inspector General's released a report that examined how 20 of the top accountable care organizations (ACOs) managed to lower Medicare spending while improving care. The OIG made several recommendations to CMS based on its review, including sharing successful strategies that reduce spending and improve quality among ACOs. The OIG also reviewed the impact of certain program changes on ACOs' ability to promote value-based care. Almost all the ACOs provided doctors with data about their own practices and referrals to increase their awareness of the cost of services and reveal any gaps in care. Several of them also educated physicians who had unusual spending or utilization trends. The OIG also found that the top organizations made it their mission to engage patients and manage hospitalizations.
• Providing up-front financial support to ACOs in rural and underserved areas was associated with lower Medicare spending per beneficiary than non-ACO beneficiaries in the same area, according to research published in The New England Journal of Medicine. CMS' ACO Investment Model provides prepaid shared savings to eligible MSSP ACOs. After accounting for $82.4 million in CMS spending ($76.2 million in prepayments and an additional $6.2 million in shared savings payments), the aggregate net reduction was $48.6 million, which corresponded to a net reduction of $10.46 per beneficiary per month, or about 1% per beneficiary per month.
• Over an eight-year period, Blue Cross Blue Shield of Massachusetts’ alternative payment model was linked to smaller increases in health care costs and better quality, according to research published in The New England Journal of Medicine. Under the payment model, called an Alternative Quality Contract (AQC), physicians receive a global budget rather than payment for each test and office visit. The study found the original 2009 AQC groups yielded average savings of 12% on claims costs from 2009 to 2016, with savings accelerating over time. The results also showed that patients in the AQC received improved quality of care for chronic diseases such as diabetes and high blood pressure and had fewer unnecessary lab tests, imaging and emergency room visits than peers in comparison states and nationwide.
• The average loss ratio of the five health insurers that bring in the most premiums from short-term insurance policies was 39.2% in 2018, according to the National Association of Insurance Commissioners' 2018 Accident and Health Policy Report. In contrast, the average loss ratio among comprehensive major medical plans purchased by individuals in 2018 was about 73%. The data raises questions about the value of enrolling in a short-term health plan, insurance experts said. The Trump administration expanded access to short-term health plans last year.
• FDA fast-tracking of cancer drugs, which for decades was reserved for emergencies, has become routine in recent years, The Wall Street Journal reported. Many of these new drugs are getting the green light based on surrogate measures of effectiveness, such as slower tumor growth, but without clear evidence that they prolong life. The result: "Families and doctors are thrust into a new world of trade-offs, raising complex questions about the medical and financial value of drugs with limited track records." Just 12% of the drugs fast-tracked between 2015 and 2018 have shown overall survival benefit.

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