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.
COVID-19 Resource Center
As the COVID-19 threatens lives and places enormous strains on our health care system, Evolent is tracking developments that affect our partners and others who are confronting this pandemic. Visit our COVID-19 Resource Center for Providers and Plans for regularly updated information, from guidance to prevent the spread of coronavirus to the responses by policymakers and regulatory bodies.
Last Month's Top Theme
National and regional payers are increasing their focus on value-based care in 2020, expanding existing partnerships and launching innovative new programs.
- UnitedHealth said 35,000 people have signed up for its Harmony plan in its first market, Southern California, since the company began selling it to employers there in the second half of 2019. Harmony is a narrow network plan built around Optum physicians and a small number of outside providers. Under contracts with Harmony, providers agree to share in risk for medical costs. United is paying agents sales bonuses of $100 for each member who enrolls, compared to $50 or $25 for most other plans, according to a document distributed to brokers. United plans to expand Harmony to Seattle and Texas. Premiums for Harmony are lower than competing plans from Kaiser Permanente and Cigna, according to rates for Los Angeles County-employee medical plans posted to the county's website.
- Humana is launching a new value-based care model to address social determinants of health among its Medicare Advantage members. The model will initially focus on food insecurity, housing and social isolation through covering enhanced care coordination for patient screenings, documentation of findings and linking patients to resources. Oschner Health System in Louisiana is the first health system to sign onto the model.
- Blue Cross and Blue Shield of North Carolina has added its eighth health system to its statewide Blue Premier value-based care program, FirstHealth of the Carolinas. FirstHealth operates four acute care hospitals and seven urgent care locations, reaching patients in 15 counties. Atrium Health, Cone Health, Duke University Health System, Novant Health, UNC Health Care, Wake Forest Baptist Health and WakeMed Health & Hospitals have previously agreed to participate in the model. The addition of FirstHealth brings Blue Cross NC closer to its goal of having 50% of its members in value-based contracts this year.
- Blue Cross Blue Shield of Michigan has added seven health organizations to its Blueprint for Affordability program, expanding its value-based payment program to 14 total organizations. The five-year contracts with BCBS start with an upside-only contract in 2020, with the providers moving to downside risk in the second year. Other physician groups and health systems in Michigan have expressed interest in being part of the model but will not go under contract until 2021. The Blueprint for Affordability model includes BCBS's commercial and Medicare Advantage PPO members, which represents approximately 30% of the covered population in Southeast Michigan.
- Priority Health, a Michigan-based health plan, is incentivizing providers to adopt the CenteringPregnancy value-based care model to combat racially driven disparities in maternity care. CenteringPregnancy is an evidence-based model that provides prenatal care in a group for women who are around the same stage of pregnancy, improving prenatal routine adherence and increasing patient satisfaction. Priority Health provides this model to Medicaid members for free.
Payers and Providers
- Walmart will launch its first narrow networks for its employee health plan in 2021 in three markets in 2021: Northwest Arkansas, the Orlando-Tampa area and the Dallas area. The initiative is a big change from Walmart's traditionally broad PPO networks, and the company hopes the new approach benefits not only its enrollees but also clinicians in those regions. It's also a move beyond the company's earlier contracting with accountable care organizations. The curated networks stem from positive clinical results and employee experiences that Walmart saw in its Centers of Excellence (COE) program. In 2013, Walmart began offering employee health plan enrollees care from COEs for an expanding list of treatments that include joint replacement, spine surgery, cancer care and organ transplants.
- Cleveland Clinic + Oscar, which began offering individual health plans to people in five Ohio counties at the beginning of 2018, expanded operations to three additional counties at the beginning of the year. The two organizations share risk equally in their value-based partnership. The plans cover only care provided by Cleveland Clinic's network. Though it's still early to assess 2019 results, a Clinic executive said they had 22% market share last year and an 85% renewal rate for 2020.
- Catalyst Health Network and UnitedHealth's accountable care partnership in North Texas has yielded positive results for its beneficiaries, increasing annual preventive screenings for cancer and diabetes while lowering overall health costs. Catalyst Health Network, a clinically integrated network of independent primary care physicians, has significantly ramped up efforts for cancer screenings, with breast, colorectal and cervical cancer screenings increasing by nearly 50% from the previous year. They also closely monitored their diabetes patients, increasing the number of screenings for diabetic retinopathy and nephropathy by nearly 50% while reducing A1C levels in nearly 25% more patients than the previous year. Catalyst and United have also successfully reduced utilization of out-of-network providers while shifting site of care to lower-cost facilities, driving savings of more than $10 million in the past year.
- Priority Health is collaborating with Amazon to provide members with an HSA or FSA a branded digital storefront that offers a convenient way to order and pay for eligible items. Commercial group and individual members can either use their HSA or FSA debit card on their Amazon account for easy reimbursement or use their regular Amazon account and submit receipts.
- Alignment Healthcare, a Medicare Advantage plan, raised $135 million in Series C funding from Fidelity Management and Research Company. To date, Alignment has raised $375 million and will continue to invest in its technology platform while accelerating growth. Currently Alignment provides a personal care team and 24/7 on-demand concierge and a technology-based "command center" that helps identify members' changing care needs in real time.
- ChenMed-operated Dedicated Senior Medical Centers in Columbus, Ohio are now accepting Aetna Medicare Advantage HMO and PPO members. The three Columbus-area primary care clinics were established through a partnership between ChenMed and OhioHealth and promise extended facetime between patients and providers and coordinated care efforts. By the end of August 2020, ChenMed hopes to operate nearly 80 medical centers in 10 states.
- Nephrology Associates, P.C., a Tennessee-based nephrology group, has partnered with InterWell Health, a national network of nephrology practitioners focused on adopting value-based care. "We're committed to delivering first-in-class care to our patients not only in Middle Tennessee but throughout the state," said David Arrieta, Nephrology Associates CFOO. "InterWell Health is unique in providing broad physician collaboration in new care models that address the needs and goals of our patients, physicians and payers."
- axialHealthcare, a care optimization company for substance use issues for patients, providers and health plans, closed $15 million in equity financing to accelerate its expansion into the substance use disorder treatment and recovery sector, led by previous institutional investors Oak HC/FT, .406 Ventures, BlueCross BlueShield Venture Partners (BCBSVP) and Sandbox Advantage Fund. When patients in need of treatment are identified, axialHealthcare’s clinical team assesses individual patient needs, connects them with appropriate treatment and provides peer recovery support specialists to guide them throughout their journey to sustained recovery. To assist overburdened providers, peer recovery specialists engage patients on a consistent and long-term basis to encourage care plan progress and connect to community and social resources, all in support of sustained recovery.
- Ginger announced that it acquired fellow digital mental-wellness company LiveBetter's technology assets. Ginger will integrate LiveBetter's technology into its member-based behavioral health platform. LiveBetter has focused on bringing virtual mental health tools to smartphone users for free. Ginger focuses on providing digital mental health services including behavior-health coaching, video therapy, tele-psychiatry visits and other self-guided content, and it specifically targets those dealing with anxiety and depression.
Government and Regulatory
- The Supreme Court announced that it will review the latest challenge to the ACA, with oral arguments likely to occur in October or November 2020 and a decision expected no earlier than March 2021. In 2018, a federal district judge in Texas held that because Congress eliminated the individual mandate penalty in 2017, the individual mandate was unconstitutional and not severable from the rest of the law, rendering the entire ACA unconstitutional. A federal appeals court affirmed the district court’s decision that the individual mandate was unconstitutional but remanded the case to the district court with instructions to reconsider which parts of the ACA could still stand. The Supreme Court in January rejected a request from the Democratic-led states defending the ACA to review the case on an expedited timeline, which would have likely led to a ruling before the 2020 election. The Supreme Court's decision ensures that the ACA and its key provisions—including protections for people with preexisting conditions—will remain front and center through the 2020 election.
- CMMI has selected 205 applicants across 36 states and the District of Columbia to participate in the Emergency Triage, Treat and Transport Model. The five-year, voluntary model is intended to give additional flexibility to ambulance care teams to provide appropriate emergency services to fee-for-service Medicare beneficiaries. Under the model, Medicare will pay participating ambulance suppliers and providers to transport the beneficiary to a destination other than a hospital emergency department (such as a primary care doctor's office or urgent care clinic) or to initiate treatment in place in person or via telehealth. CMS has encouraged coordination with ACOs on aligned goals.