3: The number of Walmart locations that the company is replacing with Oak Street Health clinics in the Dallas-Fort Worth area this fall. Newly public Oak Street has a network of 60 value-based primary care centers and the three new centers will offer preventative primary care and urgent care services focusing on patients of all ages.
5 and Dime: Payments focused on improving patient outcomes will be five to 10 times larger than what is contained in a typical outcomes-based, risk-bearing agreement under a new Blue Cross Blue Shield of Minnesota multiyear pact with Allina Health, a Minnesota health system. The provider and payer intend to cut the cost trend for care by 10% over the next five years.
Model T: In what could be the next vital healthcare innovation, Henry Ford Health System has launched a new health plan called Pivotal, which offers virtual services for in-network visits. Pivotal has over 6,000 physicians and 3,500 ancillary providers through Henry Ford.
$0 Copay: Aetna launched a new health plan, Aetna Connected, which will allow its members to make appointments at its parent company, CVS’s MinuteClinics and HealthHUBs, with no copay. The plan will also offer free at-home prescription delivery and discount on health-related items at CVS. The plan is launching next year in Kansas City, focusing on employers with more than 100 employees.
Advantage, Medicare: Like Bud Collins used to say when McEnroe got the advantage over Borg, it’s clear health systems with Medicare Advantage plans are getting ahead in the healthcare game. Sentara Healthcare and Cone Health, two nonprofit health systems each with their own Medicare Advantage plans, are merging in a value-based care model focused on digital and virtual care options in order to increase access to care. Oscar, meanwhile, is partnering with Holy Cross Health and Memorial Healthcare System to launch a co-branded Medicare Advantage plan in South Florida. Broward County residents can enroll in the new plan starting October 15, pending regulatory approvals.
On Second Thought: Michigan’s Blue plan has an agreement with 2nd.MD, which gives self-insured groups access to personalized second opinions by video or phone from medical specialists at top institutions, and, starting mid-2021, for all fully insured members.
Extra Point: A 28-year-old male from Carolina says he “wants to give up heroin but still wants a beer with his buds on the weekend.” At 16, he begins using pain pills and by 24 gets a severe illness leading to loss of job, home, and his fiancé. He moves back home with his folks by 25 and starts the cycle, back and forth from hospital emergency rooms, crisis stabilization for heroin overdose, and at one point a 28-day rehab. It’s astounding to me that more than 50 healthcare professionals talk to him during a five-year period in and out of facilities, but none treat his anxiety. At 26, one clinician’s lab workup diagnoses him with Hep C but he’s never connected to treatment after discharge. This spring, he’s alone, shut off from outsiders, trying to recover, avoiding his elderly parents to limit coronavirus risk. How this male begins to recover, the total costs of treatment and how a value-based payment model is turning his story around will be one of six case studies discussed September 22nd, during a live two-hour forum kicking off at noon eastern. Stephan Young, enterprise mental health leader for Ohio health plan Caresource, will lead off to share managed care’s view of these risk-taking solutions, including an innovative SNF program, a telepsych model, a social service program, and a pair of addiction treatment capitated models. I’m excited to host a lineup as stellar as the ’27 Yankees. Register by clicking here or reach out with questions. Registrants will also receive results from a summer healthcare consumer research poll.