Value-Based Care Intelligence Digest - November 2018

November 13, 2018

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 Topics

  1. Association Health Plans (AHPs) are picking up steam as associations and chambers of commerce partner with payers to offer AHPs as an alternative to Affordable Care Act plans.
    1. Iowa: the Iowa Farm Bureau partnered with Wellmark Blue Cross & Blue Shield to offer an AHP for its members.
    2. Michigan: The Small Business Association of Michigan and MichBusiness are offering a new AHP called Transcend to small businesses that have fewer than 50 employees and are affiliated with either group.
    3. Nebraska: Nebraska Farm Bureau has partnered with Medica to provide an AHP to members who produce at least 50 percent of their income from agriculture and have fewer than 50 employees.
    4. Nevada: Three chambers of commerce partnered with Health Plan of Nevada and Sierra Health and Life for an AHP for their collective members. In Reno, the Reno + Sparks Chamber of Commerce partnered with Prominence Health Plan to manage their AHP.
  2. More Blues/regional plans and providers announce partnerships for new insurance products.
    1. Blue Cross and Blue Shield of Minnesota and Fairview Health Services are partnering on new insurance products for 2019 under the name “Strive,” which will be available for large employers, Medicare Advantage beneficiaries and individual customers.
    2. Health Alliance Plan of Michigan (HAP) is partnering with United Physicians and Oakland Southfield Physicians in the Detroit metropolitan area to launch a Medicare Advantage HMO plan.
  3. The urge to merge: Dallas-based Baylor Scott & White Health and Houston-based Memorial Hermann Health System have signed a letter of intent to merge.
    1. Together, they would have 68 hospitals, two health plans and roughly $14.4 billion in revenue. The combined entity’s footprint would include more than 1,100 care delivery sites, about 73,000 employees and nearly 14,000 physicians. The organizations expect to reach a definitive agreement in early 2019 and finalize the merger by mid-2019. However, the deal will require approval from the Federal Trade Commission and the Texas state attorney general.
  4. Having seen national payers’ vertical integration strategies (e.g., United/Optum, Aetna/CVS), regional payers are starting to formulate their own.
    1. Earlier this year, regional payer Blue Cross and Blue Shield of Kansas City launched Spira Care, a combined primary care and insurance offering for employers. All services delivered at the proprietary Spira Care primary care centers are covered at no cost to the employee, except prescriptions, which are treated like other Blue KC plan offerings. Blue KC partnered with Vera Whole Health, a direct-to-employer primary care provider, to open three new Spira Care Centers for plan members in January 2019.

Accountable Care Organizations in Action

  1. AnewCare Collaborative, Ballad Health’s ACO comprised of providers in Virginia and Tennessee, is one of 21 ACOs in the Medicare Shared Savings Program (MSSP) to generate savings in each of their first five years, according to results released recently by CMS. Ballad officials said the ACO generated more than $46 million in total savings since 2012.
  2. Baylor Scott & White Health is offering its ACO, the Baylor Scott & White Quality Alliance, to other employers to try to bend the health care cost curve after seeing results in its own employee population. Dallas Area Rapid Transit signed onto the Baylor ACO for 2018, and the agency’s early results have allowed it not to increase employee premiums for next year as well as offer new benefits. Baylor’s employee health plan, covering about 65,000 employees and dependents, has kept costs flat for the past five years, an estimated savings of $125 million in medical spending. In 2019, Baylor’s ACO expects to cover almost 700,000 lives, 250,000 more than this year.

Provider Spotlight

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

Evolent News

  1. Evolent’s partner Carilion Clinic, located in Roanoke, Virginia, shares how their population health efforts and use of data analytics have helped them gain stronger insights into their patient population. Read this piece in Healthcare IT News to learn how Evolent’s technology platform and performance management tools have helped Carilion identify the right patients, implement the appropriate interventions and drive down costs.
  2. Participation in a Next Generation Accountable Care Organization has given providers in the OneCare Collaborative — a partnership between area physicians, hospital partners and Evansville, Ind.-based Deaconess Health System — additional resources for improving community health. It’s also reconnected them to the most fulfilling aspects of medical practice. Watch this video to hear their inspiring stories.
  3. On October 16, 2018, Evolent submitted comments to the Centers for Medicare and Medicaid Services (CMS) on its proposed rule overhauling the Medicare Shared Savings Program. While some in the industry oppose CMS’s push for all MSSP ACOs to take on both downside and upside risk, Evolent believes health care providers are capable of taking on more risk for patient outcomes when they have the right support and incentives. 

General Updates

  1. The health systems affiliated with Vanderbilt University and University of Tennessee announced their partnership to create a value-based health network that will ultimately provide coverage statewide in Tennessee. It will include their teaching hospitals, as well as 87 practices and more than 1,000 providers in University Health Network, plus the 13 health systems, 67 hospitals, more than 350 practices and more than 5,000 providers in the Vanderbilt Health Affiliated Network.
  2. InnovAge, Adventist Health and Eskaton, a provider of home health care, are planning to partner to create a new Program of All-inclusive Care for the Elderly (PACE) center in Sacramento, California. InnovAge and Adventist Health are also considering expanding the partnership to bring PACE to several other California communities. According to the U.S. Census, by 2020 there will be nearly 14,000 low-income seniors in the Sacramento area who could qualify for PACE; across California, the number is about 220,000.
  3. CareMore Health proved that integrating primary care, behavioral health and social initiatives can reduce costs and improve outcomes for Medicaid populations. They write in Harvard Business Review that from May 2017 to April 2018, when compared to other Medicaid consumers in the same geography, CareMore’s program demonstrated decreases in emergency room visits and specialist visits, among other measures.
  4. Blue Cross Blue Shield of Massachusetts and South Shore Health System launched a three-year pilot program to test and refine a value-based payment model that builds upon Blue Cross’s existing Alternative Quality Contract (AQC). Under the pilot program, the hospital’s financial payment will be tied to its success in working with physician groups in its immediate geographic area — even those affiliated with a different hospital — to provide high-quality, cost-effective care.
  5. Health Alliance Plan of Michigan (HAP) is partnering with United Physicians and Oakland Southfield Physicians in the Detroit metro area to launch a Medicare Advantage HMO plan on January 1, 2019. First-year membership for the new plan, called Primary Choice, is expected to be about 2,000 seniors. HAP currently offers nine types of individual Medicare Advantage plans with about 70,000 members. 
  6. Horizon Blue Cross Blue Shield of New Jersey reported that more than 70 percent of its in-network primary care doctors participated in one or more of Horizon BCBSNJ’s value-based care programs. This represents a 20 percent increase over the last two years. According to 2017 results, commercial members engaged with value-based providers experienced a 4 percent lower total cost of care trend (compared to all commercial members).

Government, Regulatory & Industry Pulse

  1. CMS released new guidance, effective immediately, relaxing a range of requirements for state waivers submitted under section 1332 of the Affordable Care Act (ACA). The new guidance changes guidance from 2015 that required state proposals to maintain or increase the number of people with coverage that met the ACA’s guidelines for comprehensiveness and affordability, including the 10 essential health benefits. Now a state must only make comprehensive coverage available, regardless of whether consumers buy it. The agency will also consider short-term, limited-duration plans and association health plans as coverage, even though these plans often do not cover essential health benefits.
  2. President Trump introduced an HHS proposal to reduce Medicare Part B prescription drug rates, a proposal that HHS projects will save the government and Medicare beneficiaries more than $17.2 billion over five years. The proposal would gradually shift Part B payments for some outpatient drugs, including cancer drugs and biologics, to lower international prices. This International Pricing Index Model would create a system in which physicians and hospital outpatient departments would no longer buy and bill for drugs under Part B; instead, CMS would contract with vendors to procure drugs and then distribute them to providers. The model would also change the way that physicians are paid for administering drugs under Part B. In 2006, Medicare Part B started paying physicians 6 percent on top of the average sales price. Under the proposal, providers would receive a set payment for storing and handling drugs, removing the 6 percent financial incentive to prescribe higher cost drugs.

Evolent in the News

  1. Value-based payments are continuing to grow, but many health care organizations still remain in fee-for-service models without significant investment in value-based care. Are there any risks to this approach? How should they adapt? If they increase their stakes in value-based models, how do they manage the conflict between the two models? Hear what Frazer Buntin, Evolent’s president of value-based services, had to say about these issues in a recent episode of the Relentless Health Value podcast.
  2. According to researchers at George Washington University, low patient health literacy costs were estimated to be between $1.6 trillion and $3.6 trillion in 2015. How can the industry help improve patient health literacy? Evolent’s chief medical officer, Dr. Andrew Snyder, sat down with Modern Healthcare to discuss the possible challenges and solutions to this problem.

Survey Says/Studies Show

  1. The Health Care Payment Learning & Action Network released its latest report on the uptake of alternative payment models (APMs). According to the report, APMs have grown steadily, increasing by 23 percent over the past two years; however, most payments fall into shared savings models, with just 12.5 percent in 2017 falling into models with higher risk-sharing. By line of business, Medicare Advantage plans are leading the way, with nearly 50 percent of health care dollars in APMs built on fee-for-service or population-based payment, compared to 38 percent of dollars in traditional Medicare, 28 percent in commercial and 25 percent in Medicaid.  
  2. According to a new Kaiser Family Foundation survey of state Medicaid directors, 47 states plan to offer reimbursement rate increases to at least one provider type in fiscal 2019. Twelve states plan to increase rates for primary care providers, 14 are planning to offer specialists higher reimbursement, and 21 said that they will increase reimbursement for outpatient hospitals. In contrast, 27 states do not plan to cut or freeze rates for inpatient hospitals, although they did not expressly explain why.
  3. Almost half of respondents are taking an enterprise approach to telemedicine, a 23 percent increase compared to 2017, according to the 2018 U.S. Telemedicine Industry Benchmark Survey produced by REACH Health. Organizations that operate their telehealth program as an enterprise are almost 30 percent more successful in achieving their objectives than those managed out of separate departments, according to the report. More than half of hospitals that started with a departmental approach reported that they are evolving toward or have already transitioned to a holistic one.
  4. According to the Office of the National Coordinator (ONC), nearly 80 percent of hospitals and clinicians eligible for the Merit-based Incentive Payment System (MIPS) are currently using health information technology tools that have Fast Healthcare Interoperability Resources (FHIR) capabilities, allowing exchange information between different systems. Epic Systems, Cerner Corporation, and Allscripts are among the industry leaders that have committed to using the internet-based data exchange standard in their products. This news comes as ONC prepares to release a draft rule that creates standards for the industry on how to best implement consumer-friendly interoperability technologies while ensuring privacy and security.
  5. A two-month pilot program launched by CareMore in 2016 at select CareMore locations in Southern California examined the impact of Lyft-based curb-to-curb (C2C) rides on patient experience and health care costs. During the pilot, a total of 479 rides were provided, and results were encouraging: wait times decreased by 30 percent, per-ride costs decreased by 32 percent and satisfaction rates were 80 percent. Due to the encouraging results from the pilot, CareMore expanded the program systemwide and began offering Lyft-based rides throughout all MA markets in August 2016, which included 75,000 members across 18 counties in California, Nevada, Arizona, and Virginia. By the end of 2017, CareMore provided 91 percent of all C2C rides through Lyft, accounting for up to 7,000 rides per month and a total of 68,993 rides over the course of 2017.

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