1.1B: The amount of money Highmark's True Performance value-based reimbursement program saved in healthcare costs. The savings were related to ED visits and hospitalizations and were generated from 2017-19. About 2M Highmark members see a primary care doctor through the True Performance program. Payer results in value-based care vary - one Blue plan told us they lowered cost of care by about 3%, Aetna and Cigna somewhat less, while United has saved more (7-9%). In one example the plan saved $1.5M via value-based design (which they describe as not a lot of money), keeping about $1M of that.
And the Winner Is...Humana’s MA members receive more preventative care and experience fewer hospitalizations and trips to the ER when they see primary care physicians participating in value-based arrangements compared to both traditional Medicare models and non-value-based Humana arrangements, according to a recently released study. As of 2019, two-thirds of Humana’s individual MA members receive care from primary care physicians in some form of value-based arrangement, with almost 20% assigned to PCPs participating in a global value model. Although the percentage of members assigned to doctors participating in value-based arrangements held steady over the last few years, the total number of members seeking care from physicians in these arrangements grew by three quarters of a million.
Stella or Stellar: In Massachusetts, my in-laws would call it Stella, not the beer but the new tech platform that pushes insights about patients and their conditions to physicians in Harvard Pilgrim Health’s network. Stellar Health is helping the insurer move more successfully into value-based models, tracking quality outcome measures.
Clover Care Turns to Walmart, UHC Expands: Walmart is expanding its push into healthcare, this time by partnering with insurance startup Clover to offer Medicare Advantage plans in Georgia. Members will have access to the new Walmart Health centers recently opened across the state. Both plans will offer free primary care, and one of the plans will offer $0 premiums. Members in the co-branded Clover Walmart plans will also receive a $400 a year benefit for OTC health expenses that can be used at Walmart’s physician stores or website. UnitedHealth Group, meanwhile, will expand its MA offerings to seniors in 291 new counties next year and in three new states, Michigan, Delaware, and Mississippi. Some features include $0 MA premiums in 2021 for 2.5 million members and almost all will see stable or reduced premiums; $0 copays for telehealth visits, labs, routine vision and hearing exams, colonoscopies, mammograms, and cardiac rehab; and a monthly cap on insulin at $35.
MD Burnout Fix: A new program from the United Health Foundation and the American Academy of Family Physicians will train physicians to improve their well-being and reduce burnout. COVID-19 has presented healthcare providers with additional challenges and stressors. 81% of nursing home staff say their stress and anxiety are elevated, compared to 69% among hospital staff, and 61% of clinic staff. The goal of the program is to foster a movement in family medicine that changes the culture, policies, and systems to better support clinician well-being. The program will initially train 200 family physicians and begins in January 2021.
Pharm Land: Kroger Health and its family of pharmacies, Costco, Publix, and HEB, are joining Humana’s preferred stand-alone Medicare Part D pharmacy network for 2021. This will add more than 9,000 pharmacies to Humana’s current preferred network of around 5,000 Walmart and Sam’s Clubs pharmacies.
UnShare: David would not share the one yogurt with his sister, Alexa, during a classic sibling argument in a Schitt’s Creek rerun this week. Sharing will be a big topic of debate in managed care circles over the next five years. In a straw poll of payment innovation directors for managed care plans, a majority say they will need to re-evaluate the share of savings in value-based arrangements during the next contracting period. “It’s either we adjust what we share or change the target – particularly around surgical episodes, but perhaps other conditions, particularly as more providers beat the goal.”
Extra Point: A basketball season is underway in my community. Parents are pushing for it because they want their kids to play sports. Our own kids may participate, I may or may not coach, and I can’t see how we get through one or two games without having to shut it down, but maybe I’m wrong. I hope I’m wrong. Our high school senior, Jack, starts varsity hoops in November. He has zero chance of playing college sports but also has an inflated sense of self and thinks he can walk on at Indiana or Michigan, so for his sake I hope he gets a chance to play this winter. On a Zoom with middle school parents last night, a dad shared his concerns about the contact on the court. “I mean, when the kids play defense that’s bound to be a problem,” he said. I nearly fell off my chair because his kid hasn’t played any defense ever – he stands roughly 10 feet from anyone, including his own man. So, dad’s concern, while understandable, is somewhat overstated, I think. If I coach our 8th grader, I feel good about our chances. Leave one kid basket hanging on offense, two kids in the middle of the court to pass him the ball, the other two on defense as interceptors. No dribbling, spaced, masked, modestly COVID compliant. Think ultimate frisbee with a round ball. It may be risky, and we may just lose every game, but it may be the only way to keep the kids healthy.