Phoenix-based Equality Well being presents value-based care options devoted to serving unbiased major care practices in closing gaps in care. Final June, I had the chance to interview Mark Stephan, M.D., M.B.A., the corporate’s chief medical officer, about Equality Well being’s ’Medicaid-first” enterprise mannequin.
“The best way we enter markets is within the Medicaid house, however we even have Medicare Benefit contracts and we’re in ACO REACH,” Stephan informed me. “It’s vital to carry a portfolio of value-based agreements to a observe. It helps with mindshare and habits change and observe transformation when you might have a big a part of your panel in a value-based settlement.”
In December I had the prospect to listen to extra about how this performs out from the doctor observe perspective by speaking to Victoria Blanken, govt director of Highlands Physicians Inc., a 1,400-physician unbiased doctor affiliation in east Tennessee and southwest Virginia.
I requested Blanken what was enticing to Highlands about working with an organization like Equality Well being.
First, she stated, Highlands runs as a really lean group, and most of its earnings return to the physicians to assist them preserve their monetary independence. Among the many many challenges her workplace faces is working with greater than 40 totally different EHRs, however she stated Equality Well being is working to combine knowledge from these EHRs into their Care Empower software program.
“We have a look at it as an obligation to make it possible for we assist our neighbors in want. For 2 of our counties, the poverty charge is sort of 15 %, which is above the nationwide common. We wanted a associate that might carry not simply technological items and options to us. We wanted the flexibility to have extra funding for the human useful resource we wanted, extra boots on the bottom, if you’ll, in these communities,” Blanken stated. “Equality Well being’s enterprise mannequin includes hiring native residents to work in our community-based organizations to make outreach calls. That was so essential to my physicians in a market the place mergers and acquisitions are going down at alarming charges. Despite the fact that our associate is predicated in Phoenix, we nonetheless really feel like Equality Well being is an area associate to us, as a result of that is how they make you’re feeling by hiring native individuals providing help.”
She described how Equality Well being redeveloped its cultural care coaching mannequin, which had been largely geared towards Hispanic populations, to characterize the Appalachian Highlands space. “That’s an outstanding partnership when you might have a associate that meets you the place you might be, and meets your neighborhood members the place you might be.”
Traditionally, she stated, Highlands’ physicians by no means made cash within the Medicaid house. However they continued to work in it as a result of they consider it’s their obligation. “Equality Well being provides us the flexibility to be financially sustainable and care for our inhabitants that wants it probably the most,” Blanken stated.
Earlier than partnering with Equality Well being, Highlands had already begun so as to add care coordinators and neighborhood well being staff on a small scale, she famous. “However now our partnership with Equality Well being has allowed us to broaden that in order that we’re actually taking good care of the inhabitants. You must stratify danger. Equality Well being has allowed us to broaden that in order that we’re taking good care of extra individuals.”
I requested if that has resulted in financial savings from fewer emergency room visits or hospitalizations.
Blanken stated that as a result of they’ve solely been working on this house for rather less than a 12 months, it’s too early to share quantitive knowledge.
Becoming a member of our dialog was Larry Inexperienced, Tennessee market president for Equality Well being. Earlier than becoming a member of Equality, he has served as an govt with well being techniques comparable to Ascension Well being, Advocate Aurora Well being, and HCA Healthcare. He has centered on varied risk-based monetary reimbursement mechanisms in addition to constructing value-based care fashions, clinically built-in networks, and accountable care organizations.
I requested Inexperienced if there was one thing about Tennessee that was interesting to Equality Well being as a market to enter.
“Tennessee was superior with regard to various cost fashions. They have been far alongside by way of the value-based care journey juxtaposed with another states,” he replied. “There was regulatory alignment and there was an actual development alternative. Additionally, a number of of the well being plans have a well being fairness focus. WellPoint has been acknowledged for his or her work within the well being fairness house in addition to Blue Cross and Blue Protect of Tennessee. Additionally, there are someplace between 500,000 and 600,000 Medicaid enrollees who reside in rural Tennessee. That was an intriguing ingredient to maneuver into Tennessee and to start our work in East Tennessee with Vicki and Highland extra broadly.”
Blaken stated her group is utilizing Equality Well being’s Care Empower software program to benchmark the affected person — what their HCC [Hierarchical Condition Categories] rating was and what number of instances they have been in a position to get into their major care doctor. “We’ll have a look at these measures and see if we will enhance them,” she stated. “Due to the settlement we’ve with Equality, our contracts with the managed care organizations are a lot better than they’d have been have been we not with a value-based associate on this house that had a historical past of being profitable in managing their sufferers. So even from the start, the contract negotiations have been higher.”
Altering topics and talking from a coverage perspective, Blanken stated extra must be completed to help rural suppliers. “We’re withering on the vine out right here,” she stated. “There have been 16 hospital closures this 12 months and 13 of these are rural. Tennessee was the second-largest for hospital closures in rural areas.”
The merger and acquisition market has made it more and more troublesome to stay unbiased, she added. “The IPA has helped unbiased physicians keep unbiased. However we have seen an alarming variety of practices transfer into bigger practices or multi-specialty practices just because they can not afford to maintain their doorways open. Between that and the hospital closures, I haven’t got to let you know how vitally vital it’s to discover a resolution to this drawback.”
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