Blog | Innovation and Disruption

Analysis: Health plans, physician practices align to manage population health and reduce total cost of care

Blog | Innovation and Disruption

Analysis: Health plans, physician practices align to manage population health and reduce total cost of care

  • The variety of strategies health plans are deploying to align with physicians and manage referrals may challenge the long-held belief that hospitals and health systems would be the network organizers and bear longitudinal risk in many (if not most) markets as the U.S. health system transitioned to population health-based payment models.
  • Last Thursday, Blue Shield of California revealed information about its new technology and services company Altais, which is slated to help physician practices remain independent and give them tools needed to succeed in value-based care arrangements.
  • This strategy can help standardize patient workflows and help practices create a single senior care strategy that works for Blue Shield’s MA members who are cared for by the practice and the practice’s Medicare FFS beneficiaries.

Modern Healthcare reported Aug. 29 that Blue Shield of California unveiled new details about the technology and services company Altais it is launching to help physician practices remain independent while giving them tools needed to succeed in value-based care arrangements.

Altais is partnering with the California Medical Association and a Aledade, a Bethesda, Md.-based company that helps physicians launch accountable care organizations, according to the article. Altais and its partners will offer independent doctors and practices tools to improve patient health outcomes while making it easier for them to focus on care instead of administrative tasks, the Modern Healthcare article reports.

“Blue Shield also said it plans to support physicians in moving toward value-based care by investing in their practices,” according to the article. Investments could range from different types of affiliations to even employing the doctors in select situations, though employment it not the primary objective.”

“Blue Shield created Altais because fewer and fewer doctors are staying independent. Physician practices are burdened by administrative work and sometimes can't afford to upgrade their technology or acquire tools to succeed in new payment models,” said Dr. Jeff Bailet, Altais' CEO and former executive vice president of healthcare quality and affordability at Blue Shield in the article.

“Blue Shield's Altais venture appears to share some similarities with Optum, though a spokesman emphasized that Altais is unique in that it will focus on physicians and clinicians and deliver more help and support while reducing burden beyond what other technology companies provide. A previous news release also said Altais is in discussions to deliver primary and specialty care,” the article says.

“Altais through the collaboration will offer a set of tools to help physicians succeed in value-based care models. Those tools include population health support, predictive analytics, as well as tools that reduce burden by providing real-time transcription of a patient visit, for example,” the article continues. “Altais will also help with back-office functions like billing and credentialing.

“The three organizations will work with payers in the state to offer value-based arrangements to reward physicians for better care. Blue Shield has committed to offering such an arrangement for primary care in 2020 to physicians working with Altais and Aledade. Aledade is already collaborating with the California Medical Association to create physician-led accountable care organizations to participate in the Medicare shared-savings program.”

Takeaway

Conventional wisdom has long held that hospitals and health systems would be the network organizers and bear longitudinal risk as the U.S. health system transitioned to population health-based payment models. However, I’m not sure that’s going to be the case in many (if not most) markets given the variety of strategies health plans are deploying to align with physicians and control referrals.

Alternative alignment options for physicians

The most notable example is Optum’s aggressive employment of physicians, as noted above, but there are plenty of other examples — such as Humana piloting a telehealth-only offering, currently only for small employers; CVS/Aetna’s use of health hubs — of plans trying to better manage care and disrupt traditional referral streams.

And what Blue Shield is doing is just another alternative alignment option for physicians. Beyond providing infrastructure, this strategy can help standardize patient workflows for practices that elect to participate in the MSSP program as part of this. In effect, that helps the practice create a single senior care strategy that works for Blue Shield’s MA members who are cared for by the practice and the practice’s Medicare FFS beneficiaries.  Like all ACOs, this one will develop evidence-based care pathways for common chronic conditions. And they will use data to help identify which providers are most efficient. So, I would imagine that this could change referral patterns for services ranging from inpatient admissions to diagnostic services in markets where there are multiple options.

While the quality measures for both programs are different, the analytics and care coordination platform/capabilities necessary to be successful are the same. And in the process of helping practices stay independent, there will likely be a halo effect from participating practices that improve quality (and HEDIS scores) for Blue Shield’s MA members and capture complicating conditions that will increase the Medicare Advantage members’ HCC score. These activities will increase revenue to the Medicare Advantage plan. So, there’s a potential to increase the topline while reducing medical expenditure.

Cigna in some markets is providing a similar option for physicians. I wouldn’t be surprised if more plans take this approach moving forward. 

About the Authors

Chad Mulvany, FHFMA

is director, healthcare finance policy, strategy and development, HFMA’s Washington, D.C., office.

Advertisements

Related Articles | Innovation and Disruption

How To | Revenue Cycle Technology

How to prepare your revenue cycle and your employees for a digital workforce

Transitioning the revenue cycle process to a digital workforce should include integration of a strategic human workforce plan to manage employee anxiety about job redeployment and attrition.

Blog | Innovation and Disruption

Analysis: Why Walmart should be on your list of disrupters

A review of why Walmart should be on your list of disrupters.

Blog | Innovation and Disruption

Analysis: Optum to empower its physicians via advanced analytics to improve care and coordinate referrals

Once OptumHealth links its physician network to data it gleans from its data analytics engine, referrals from Optum employed and aligned providers will move from high-cost providers to lower-cost, more conservative ones.

Research & Reports | Payment, Reimbursement, and Managed Care

Navigant Consulting, Inc.: Hospitals and Health Systems Prepare to Assume More Risk

: This research highlight discusses key takeaways from a May 2019 HFMA study of hospital and health system senior financial executives about their organizations’ interest in and capabilities for assuming risk.