Value-Based Care Intelligence Digest - April 2018

April 9, 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. Payers and providers continue to make major moves in the PBM space as consumers and employers increase pressure on health plans to contain rising prescription drug costs
    1. Cigna announces that it will buy the nation’s largest PBM, Express Scripts, for $67B. Express Scripts faced financial pressure after it lost its largest client, Anthem, which plans to launch its own PBM, IngenioRx, in 2020. Source
    2. Centene invests in full service, cloud-based PBM, RxAdvance. Source
    3. Meanwhile, CVS Health and Aetna’s shareholders sign off on the proposed $69B merger, though it may face significant hurdles in obtaining regulatory approval. Source
    4. Providers are also entering the PBM space in response to shortage of supply and skyrocketing drug prices. Intermountain, Ascension, Trinity and SSM Health join forces to create a new non-profit company that will provide generic drugs to hospitals. Source
  2. Non-traditional giants set their sights on a bigger piece of the health care pie
    1. Walmart is in preliminary talks to buy Humana. No financial terms have been disclosed, but it will likely be Walmart’s largest deal. Walmart’s foray into health care primarily involves being a drugstore operator and operating some retail clinics. Source
    2. Uber introduces Uber Health, a new non-emergency ride service that health care providers can use to schedule rides for patients. However, it is not clear the answer to missed appointments is ridesharing. A recent JAMA study found that for Medicaid patients, the uptake of rideshare-based transportation is low and is not associated with a reduction in missed primary care appointments.
    3. Google parent company, Alphabet, is considering a move into the health insurance business. Verily, Alphabet’s health care unit, may also enter the population health/care management business. Source
  3. Hospital CEOs are rethinking growth strategies as patients seek care outside of hospitals 
    1. Ascension and Providence shelve merger talks that would have created the largest hospital system network in the nation. Ascension CEO, Anthony Tersigni, made clear in a recent Modern Healthcare interview that the company is looking to decrease its hospital footprint and will work to partner with post-acute, home health and ambulatory providers. Source
    2. CHS sells three more hospitals, after selling off 30 hospitals in 2017. CHS will look to sell struggling hospitals in 2018 to add $2B in revenue, according to CHS CEO Wayne Smith. Source

PROVIDER SPOTLIGHT

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

Evolent Partner News

  1. The CEO of True Health New Mexico discusses how their partnership with Evolent Health will bring better care at a lower cost to more people in the Southwest.
  2. On March 14, Passport Health Plan broke ground on a 20-acre campus in West Louisville, Kentucky. They’ll move 500 employees to a new health and wellness campus, with plans for low-cost, high-quality food stores to address the food desert, and job training programs and more to address social determinants of health issues. Check out the case study by Passport CEO Mark Carter and Evolent Medicaid President Mike Minor in the April edition of hfm Magazine (subscription required). 

General Updates

  1. Navicent Heath announces a six-year outcomes-based partnership with GE Healthcare to reduce cost and improve patient care in Central Georgia. The collaboration will target clinical, operational and financial outcomes to promote growth and synergy across the system.
  2. Arizona Care Network will pilot a blockchain platform developed by Solve Care to improve clinical outcomes, relieve administrative burden and reduce waste.
  3. Geisinger and St. Luke’s University Health Network will build and co-own a hospital in Pennsylvania. This will be the state’s first hospital co-owned by two health systems.
  4. UPMC, Washington Physician Hospital Organization and Cigna collaborate to provide enhanced coordinated care to improve health, affordability and patient experience in Western Pennsylvania.
  5. Hartford HealthCare and Tufts Health Plan announce joint venture to form a health insurance company called CarePartners of Connecticut to offer Medicare Advantage plans to senior citizens. This partnership is the first payer-provider collaborative Health Plan in Connecticut.

GOVERNMENT, REGULATORY AND INDUSTRY PULSE

Federal

  1. Trump removes Dr. David Shulkin as VA Secretary. His removal comes at a critical point in the VA Choice program debate and in the midst of Shulkin’s efforts to modernize the VA’s EHR system. Trump announced that he will nominate presidential physician, Dr. Ronny Jackson, to be the new VA secretary.
  2. New group of U.S House of Representatives lawmakers, The Health Care Innovation Caucus, plan to push federal policies on value-based care models and accompanying technologies. It is unclear what policies the caucus will work on immediately.
  3. The federal government dropped most of its False Claims Lawsuit over UnitedHealth Group’s alleged fraudulent Medicare Advantage payment practices. This move may serve as an indication to other payers under investigation for Risk Adjustment upcoding issues, including Aetna, Health Net, Humana and Cigna.

EVOLENT IN THE NEWS

Follow our Knowledge Center for additional insights.

  1. Evolent Health supports ten ACOs accepted to the Next Generation ACO program for the 2018 Performance Year. Read the press release.
  2. Passport Health CEO Mark Carter and Evolent Medicaid President Mike Minor explain how Passport Health became a model of a resilient, forward-thinking hospital-sponsored Managed Medicaid program in the April edition of hfm Magazine (subscription required). 
  3. Houston Methodist’s Dr. Julia Andrieni sat down with Evolent’s VP of Clinical Transformation Dr. Michael Udwin to share insights from their new chronic kidney disease program. Find out how the data-driven program is improving kidney outcomes in Modern Healthcare. Dr. Julia Andrieni and Dr. Janice Finder from Houston Methodist spoke with Hospital Peer Review about their population health model to address end-stage renal disease. Stand by for the published Hospital Peer Review article in May to learn more about the program and Evolent’s important role in its development.   
  4. Physicians from Deaconess in Indiana connected with Hospital Peer Review to discuss how their population health initiatives, thanks to data from Evolent, are improving patient outcomes. Stay tuned for the final piece coming this spring.

STUDIES SHOW

  1. HealthLeaders Media released its Annual Industry Outlook Survey of 110 health care organizations and found:
    1. Patient Revenue: The majority of net patient revenue (74%) is fee-for-service and 19% value-based care. Respondents expect value-based payments to increase to more than 30% and FFS payments to decrease to below 60% in three years.
    2. Patient Revenue: Rural organizations only have 10% of net patient revenue tied to value-based care as opposed to their non-rural counterparts that have more than 21% of net patient revenue tied to value-based models.
    3. ROI: 34% of respondents say their investments in VBC over the past five years has yielded a strong (10%) or moderate (24%) ROI. 26% of respondents report receiving no ROI yet.
    4. Barriers to VBC: Respondents listed inadequate payer incentives, inadequate risk-based contracting models and revenue stream uncertainty as the top three barriers to pursuing VBC models with more vigor.
    5. IT Investments: The top area of health care IT in which respondents expect their organization to begin or increase investment over the next three years is clinical analytics by a large margin. EHR interoperability, mobile health, mobile technology, financial analytics and data-driven knowledge of patient health factors are the other areas of interest for additional investment.
    6. Increasing PCP capacity: 35% of respondents say their organization will fuel financial growth through M&A with physician organizations.
  2. While health care executives are seeing ROI on value-based contracts, EHRs do not do enough to help manage VBC contracts, according to a survey of 100 health care executives released by Sage Growth Partners. The report found that “64% of respondents said EHRs haven’t delivered many critical value-based tools. At least 60% of respondents said they are looking for value-based solutions beyond EHRs.”
  3. A research letter published by JAMA, raises concerns that smaller hospitals and provider groups may be left behind in the move to value-based care. According to a study of the 799 hospitals that have participated in the Comprehensive Care for Joint Replacement (CJR) bundled payment program, larger hospitals with greater patient volume achieved savings, while smaller hospitals did not. Medicare recently implied low-volume hospitals in 33 metropolitan statistical areas could opt out of CJR.
  4. A new analyses released by Avalere projects says that as many as 4.3 million people are projected to leave the individual and small group insurance markets to enroll in association health plans. Association health plans are not subject to the same rules and consumer protections as other health plans sold under the ACA and can significantly weaken the individual health insurance market.
 
 

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Building a Resilient Managed Medicaid Program in the Face of Uncertainty
Building a Resilient Managed Medicaid Program in the Face of Uncertainty

Passport CEO Mark Carter and Evolent national Medicaid President Mike Minor author an article in HFM Magazi...

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