Many health insurers have spent close to a century operating under fee-for-service and are now changing course. Some new payers founded post-health reform, however, are trying to hit the value-based ground running.
In Connecticut, the backyard of some especially large insurers' corporate headquarters, the HealthyCT cooperative insurer is piloting a care coordination and chronic condition management program with primary care practices across the state.
Founded by a group of physicians with loans authorized by the Affordable Care Act, HealthyCT has partnered with a dozen-plus physician practices and the consulting company Qualidigm to launch the Advanced Practice Medical Payment Model, offering providers incentive and payment schedules based on the patient-centered medical home.
The co-op's model is geared toward helping practices afford the costs of expanding access for patients with complex and chronic conditions like diabetes and heart disease. It's also trying to have more and more of its network -- which is offered in whole in all its plans, as a differentiator from the many narrow network plans available -- following patient-centered medical home models and emphasizing primary care.
"We've worked closely with a variety of primary-care practices, from solo practitioners to multi-specialty groups, and Qualidigm over the past year to define program requirements and appropriate incentives," said HealthyCT CEO Ken Lalime, the former executive director of the Connecticut State Medical Society Independent Practice Association. "The result is a model we all believe will be sustainable over time and reward those practices that improve quality and the health of their patients while lowering healthcare costs."
"Aligning incentives to create behavioral change is critical in transforming healthcare," added Qualidigm CEO Tim Elwell.
In another bid to differentiate itself and draw in customers, HealthyCT is partnering with Fresh Nation, an online farmers market of sorts, to promote healthy eating and offer members in Fairfield County a 10 percent discount and free home delivery.