Payer-provider partnerships eyed for population health

Despite the marketing buzz carried by terms like “population health” and “integration,” experts say this kind of regionalization works best with partnerships between providers and commercial payers.

 

That’s especially true if health systems want to reduce the reliance on fee-for-service reimbursement, said Seth Frazier, chief transformation officer at Evolent Health, a joint venture of UPMC Health Plan and The Advisory Board Company that consults with payers and providers.

 

After working in 25 regions since 2011, Frazier said Evolent has found population health hinges on a financial relationship that allows providers to earn returns for improving population health — a sustainable reimbursement that places financial value on prevention and disease management, while giving clinicians more freedom to pursue patient-centered medicine.

 

A number of insurers have embraced collaboration, from the nonprofit Blues to national for-profit payers.

 

In greater Raleigh, Blue Cross and Blue Shield of North Carolina has inked a reimbursement contract with WakeMed Key Community Care, an Accountable Care Organization formed from a collaboration between WakeMed Health & Hospitals and Key Physicians. The partnership brings BCBSNC members a range of primary care-focused services, including chronic disease support, online communications and hospital and specialty care navigation, and is helping the health system scale and extend its participation in the Medicare Shared Savings Program.

 

Various other Blue Cross companies are making a torrid push into value-based care, among them greater Philadelphia’s Independence Blue Cross and Washington State's Regence Blue Shield. On the national front, Aetna has its own internal ACO strategy that involves provider revenue stability, while Humana is working with Evolent and leveraging the consulting company’s provider clientele.

 

Evolent’s “payer value alliance” has three broad aims: aligned contract templates for creating and capturing value, establishing network of payer and provider relationships, and “built-for-purpose infrastructure including technological, financial and risk management, and population health platforms,” the organization said.

 

“We're able to streamline the process of value-sharing contracting with these leading providers,” said Renee Buckingham, Humana’s enterprise vice president.

 

Evolent’s Frazier said that health systems’ opportunities vary across the country. In some regions they can set up long-term stable payer partnerships, while in other places they may be well-served by launching their own health plan, “but we don’t see that as a necessary part,” he said.

 

As for scaling the population health model across commercial, Medicare and Medicaid patients, Frazier said the larger the population the easier it may be to innovate, especially when it comes to technology. For example, Cleveland Clinic and UT Houston are testing mobile stroke units to speed up treatment.

 

“We need to change the delivery of care,” Frazier said, specifically targeting primary care for chronic disease. “10 minute office visits don’t have that capacity,” for diabetes, heart failure, asthma and numerous other conditions. Giving primary care practices the resources to work in teams and consult patients longer, as well as opening walk-in clinics and establishing on-site clinics for large employers are all be viable options health systems are trying out.