Value-Based Care News Digest - July 2019

This month's roundup highlights the myriad ways that health systems are seeking to grow and diversify revenue, innovations to address social determinants, and other moves reshaping health care value.

Top Trending Themes

1. Health systems are exploring different paths to growth and diversification
   • Health services revenue growth:
     • Horizontal integration: Some systems are taking a more traditional approach to grow via mergers, as Sanford Health/UnityPoint Health, NorthShore University Health System/Swedish Covenant Hospital, and South Shore Health/Wellforce announced M&A or partnership talks this month.
     • Primary care capitation: Yet, we are seeing other health systems begin taking approaches other than horizontal integration. Intermountain Health acquired HealthCare Partners Nevada from DaVita Medical Group this month, marking its expansion into Nevada. This move furthers Intermountain's primary care capitation strategy; it has 2,400 physicians and 160 Intermountain clinics as part of Intermountain Medical Group.
   • Non-health care revenue diversification:
     • M&A: Providence St. Joseph Health announced it will acquire Bluetree, a consulting firm that specializes in managing Epic electronic health record systems, noting the deal as part of the health system's efforts to diversify revenue streams. Bluetree has built a client base of more than 140 hospitals since it was founded in 2012 by former Epic executives.
     • Venture arms: Banner Health and UnityPoint Health both recently announced that they are launching investment arms, joining the ranks of other health systems who have done the same, such as UPMC Enterprises, Intermountain Ventures, Kaiser Permanente Ventures and Mayo Clinic Ventures. How many hospital system venture capital firms can the market support?

2. Shopping spree: UnitedHealth Group acquired at least two businesses this month that it will add to Optum Health, which passed $100 billion in revenue for the first-time last year
   • Additions to Optum Health:
     • DaVita Medical Group practices in California, Colorado, Florida, New Mexico and Washington, from DaVita, Inc. for roughly $4 billion. The combination will serve more than 80 health plans and 16 million patients.
     • Equian, a health care payments firm, from private-equity firm New Mountain Capital for roughly $3.2 billion. Equian provides payment-processing services and tools that study insurance claims, aiming to lower overpayment risks. Mountain Capital says Equian represents 9 of the 10 largest health care payers, but the company sells to other types of insurers as well, giving UnitedHealth an opening to expand beyond health care.
   • Addition to United Health’s Research Operation:
     • PatientsLikeMe, which provides a social network on which patients can connect to people with similar health conditions, from China-based iCarbonX, for undisclosed terms. The health technology startup was forced by the Trump administration to sell because its majority owner was a Chinese company.

3. Ride-sharing companies Uber and Lyft announce channel partnerships to help grow their health care user base—with each targeting different populations
   • Uber Health, focused on self-insured employers, announced new partnerships this month with:
     • Pack Health, which operates a health coaching platform for chronic care management, to help patients with chronic conditions get free rides to their medical appointments. Patients who need a ride do not need to have the Uber app; they will receive a text message with the time of the ride on their phone and can send a text message response when they are ready. The rides are covered by Pack Health as part of the membership of participating in one of Pack Health's programs.
     • Grand Rounds, which provides guidance to employees of partner organizations on their medical needs, to cover the cost of trips to the doctor. The Uber interface is being integrated directly into the Grand Rounds platform so members can book rides there. Grand Rounds works with more than 100 large employers and reaches more than 4.5 million covered lives.
     • Carisk, a specialty risk transfer and care coordination company, to provide transportation for injured workers in workers’ compensation cases. All patient scheduling for rides is handled through a web-based dashboard, and text messages alert the user to trip details. Carisk serves insurers, government entities, self-insured plan sponsors and other managed care organizations with solutions that include risk-transfer and care coordination of delayed recovery and complex, catastrophic cases
   • Lyft will focus on government programs, as evidenced by:
     • Becoming an enrolled Medicaid provider in Arizona this month as a non-emergency medical transportation provider. In the announcement, Lyft expressed a desire to partner with other state Medicaid programs.
     • Statements earlier this year about its impact with its first Medicare Advantage partner, CareMore, and its focus on Medicare Advantage as a major growth area.

Industry News

Payers And Providers

• Blue Cross and Blue Shield of Minnesota (BCBSMN) and North Memorial Health announced a joint venture agreement with both organizations becoming shared owners of 20 North Memorial Health clinics in the Twin Cities area. A key goal of the shared ownership structure is to reduce the overall cost of care by up to 20 percent over five years, with a focus on value-based care. The joint venture makes real on BCBSMN CEO Craig Samitt's comments at a conference in April about the payer's thoughts on getting into care delivery: "If the systems are using excuses and not changing fast enough to accept risk or to evolve their clinical models, then let's get into the supply chain [care delivery], and step out of our traditional lane."
• Harvard Pilgrim Health Care has entered into an agreement with ProgenyHealth to manage the care of Harvard Pilgrim members during and after their time in the neonatal intensive care unit (NICU) or special care nursery. The core components of the program available to Harvard Pilgrim members include: Utilization Management (ProgenyHealth will work with providers throughout the infant's admission to authorize the appropriate level of care); and Case Management (ProgenyHealth case managers will work with families from admission to 60 days post-discharge and assist with discharge planning.
• Christiana Care Health System and AmeriHealth Caritas Delaware entered into a value-based payment agreement for Medicaid beneficiaries. The two organizations have agreed to share accountability for the total cost of providing health care services to Medicaid members being cared for by Christiana Care providers. Through new payment models, the organizations hope to explore interventions traditionally not covered under fee-for-service, such as nutritious food for chronically ill individuals and support for transitional housing for homeless individuals with chronic conditions.
• Humana and Epic announced a partnership agreement through which Epic will deliver real-time pharmacy data and cost information, allow provider organizations to easily share clinical data, improve timeliness for prior authorization decisions, and provide clinicians with relevant quality and cost information as they make referral decisions at the point-of-care. Humana estimates that roughly half of Humana Medicare Advantage members already see a doctor who uses Epic's platform.
• UnitedHealth Group plans to invest around $8 million over the next five years to launch a data science initiative with the Atlanta University Center Consortium, a group of historically black colleges and universities. United cited its recognition that cultivating talent in data analysis will be critical to achieving its goals for value-based care: The company covered 15 million patients under a value-based model in 2018 and is seeking to increase to 150 million people by 2025.

Accountable Care Organizations

• Cleveland-based University Hospitals is launching its Emergency Medical Services Accountable Care Network (EMS ACN). University Hospitals has an integrated network of 18 hospitals, more than 40 outpatient health centers, and 200 physician offices across northern Ohio. EMS ACN will join EMS and fire departments with other players across a 17-county region with common protocols and quality measurement. EMS ACN leaders hoped to solidify ACN participants by June, at which point work was to begin on a quality agenda and payment innovation efforts.

Telehealth And Technology

• American Well and Cisco are expanding telehealth services for homebound, elderly patients by converting home television sets into American Well-powered virtual care delivery stations. Through the partnership, the companies aim to increase elderly patients' access to hospital and health system providers by virtually connecting patients with them through their TVs.
• AdhereHealth, a health care technology company focused on medication adherence, announced a partnership with Papa, a companionship platform serving the elderly, blind and disabled. The partnership will extend the Adhere platform into the home, with Papa assisting those most in need of personal support. Adhere's analytics and clinical workflows will help direct "Papa Pals" to address a myriad of social determinants of health issues the customers face, such as transportation, shopping, housing chores and other senior services.
• Some Apple retail locations now sell a glucose monitor called One Drop that integrates with the iPhone to give people with diabetes a way to track their blood sugar through Apple's Health app. One Drop also integrates with a separate Apple Watch app. It's the only diabetes product that Apple is currently selling in its physical stores, although it previously carried One Drop online and carried a Sanofi monitor in 2012. Earlier this year, Apple CEO Tim Cook said the company’s health products will be Apple’s "greatest contribution to mankind."
• Blue Shield of California launched a new marketplace called "Wellvolution" to help people manage their health and chronic diseases through a variety of diet, lifestyle and other wellness interventions.The platform houses over 40 digital health apps and partnerships with 30,000 local brick-and-mortar options nationwide, such as YMCAs, Planet Fitness centers and weight loss clinics. Wellvolution has almost 7,000 enrollees and is averaging about 3,000 sign-ups per week.

Social Determinants Of Health (SDoH)

• Healthify and Landmark Health announced a partnership to address the SDoH for complex, chronic patients across 13 states: California, Kansas, Kentucky, Louisiana, Massachusetts, Mississippi, Missouri, New York, North Carolina, Ohio, Oregon, Pennsylvania and Washington. Through the partnership, Healthify will support Landmark's SDoH initiatives by implementing access to a national database of more than 426,000 resources. With Healthify, social workers can track the status of referrals and demonstrate improvements in patient health outcomes as a result of specific SDoH interventions through a comprehensive reporting dashboard.
• Northwell Health has partnered with Chicago-based NowPow, a startup with a platform to aid in addressing SDoH. Northwell expects the partnership to help it more effectively connect patients to community-based organizations that can help with factors like food insecurity and the lack of transportation that are preventing them from getting and staying healthy. Northwell will start providing NowPow’s services to about 1,200 Medicaid patients who are part of Northwell's Health Home, a care coordination program that provides support services for patients with significant behavioral health conditions. NowPow's software platform will draw on diagnostic codes in health records to identify patients' most urgent needs, and then use matching logic and algorithms to recommend community-based organizations to help address them.
• America's Health Insurance Plans (AHIP) is launching a new initiative called Project Link to help payers tackle social barriers such as transportation access, safe housing, maintaining a healthy diet, and other non-medical factors. Project Link encompasses three major components: 1) a learning collaborative in which payers can discuss SDoH and social barriers, sharing how to set up new programs, what tools to use for tracking results and how to know if the programs are successful; 2) the new Project Link website, which shares positive solutions for nonmedical health factors through access to AHIP staff's research, AHIP members' programs and digital resources; 3) new payer partnership opportunities with a variety of entities.

People On The Move

• Dr. Steven Safyer, the CEO who pioneered population health management at Montefiore Medical Center in New York City, is retiring after 11 years. Dr. Safyer said he will continue to serve as CEO until a successor is appointed. Since he became CEO, the number of hospitals in the system, which includes the Albert Einstein College of Medicine, increased to 10, with more than 3,000 employed physicians and more than 150 clinics.

Government & Regulatory Pulse

Federal

• President Trump signed his highly anticipated executive order on hospital and insurer price transparency, but the language leaves it up to the agencies to decide what insurers and hospitals will have to disclose. CMS will decide via rulemaking whether hospitals and insurers will need to publish individual rates or whether they can keep their pricing information more general and publish only aggregate rates. Administration officials did not confirm when the rulemaking will take place, saying only that they will use "any and all regulatory vehicles" to carry out its directives.

States

• South Carolina Governor Henry McMaster submitted a Section 1115 waiver to CMS in May, making the Palmetto State the latest to seek permission to implement work requirements in its Medicaid program. Under South Carolina's proposal, some adults enrolled in full Medicaid benefits would be required to work 80 hours per month to remain eligible for coverage. Pregnant women, people with disabilities, those with children or those receiving substance abuse treatment through Medicaid would be exempt.

Survey Says/Studies Show

• According to a new study in Health Affairs, while the number of ACOs grew fivefold from 2012 to 2018, the proportion of ACOs taking on downside risk remained relatively stable, increasing from 28 percent in 2012 to 33 percent in 2018. Overall, the majority were in upside-only risk contracts. The study authors found that ACOs with downside risk contracts were more likely to have participating providers who had experience with other forms of payment reform, such as bundled or capitated payments, and had more ACO contracts across payer types (i.e., Medicare, commercial, Medicaid).
• Most physicians' electronic health record (EHR) inboxes are clogged with system-generated messages, a problem linked to greater job dissatisfaction and burnout, according to a new study published in Health Affairs. Almost half of all weekly messages came from EHR algorithms, such as emails that remind physicians to order certain tests. Physicians that receive an above-average number of these messages tend to have more burnout symptoms and express an intention to reduce their clinical work hours.
• Almost 21% of all Medicare Advantage (MA) enrollees were offered at least one supplemental benefit in 2019, according to a new study. Of the available benefits made possible last year by a CMS rule, the highest adoption was for caregiver support plans at 17.7% of all MA enrollees, followed by in-home support at 2.2%. Just two plans in 2019 offered adult day care as a supplement. The study looked at 592 health insurance plans across 85 contracts. In total, 22 million people were enrolled in MA plans in 2019, which is 34% of all Medicare beneficiaries.
• Spending growth on five well-known low-value health care services declined slightly from 2014 to 2016, on average by 1.7% annually, according to a new report published by consultancy Altarum and funded by the PhRMA Foundation. The five low-value services used were Vitamin D screening tests; prostate-specific antigen tests in men over 75; unnecessary testing and laboratory work prior to low-risk surgery; imaging for uncomplicated low-back pain within the first six weeks; and use of more expensive branded medications when generics were available. Although spending growth on low-value services did decrease, it was less than expected given the widespread awareness and concern for the problem.

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