To move beyond the marketing buzz of "population health" and, in some places, to avoid being usurped by provider-sponsored plans, insurers need to see provider contracting more as a partnership for a community's healthcare and wellness.
Population health may have a lot of different definitions, though most have the common vision of regional healthcare systems that focus on all things preventive, evidence-based and outcomes-oriented for local communities.
But, however it is defined and branded, striving for population health in the near- and long-term is going to take partnerships that help reduce the reliance on fee-for-service reimbursement, according to Seth Frazier, chief transformation officer at Evolent Health, a joint venture of UPMC Health Plan and The Advisory Board Company that consults with payers and providers.
After working in 25 regions since 2011, Frazier said Evolent has concluded that the "key element" of population health "is a business strategy or financial relationship" to let providers "earn returns for improving population health" -- a sustainable reimbursement that places financial value on prevention and disease management, and that gives clinicians tools and resources to pursue patient-centered medicine.
Some hospital systems that have wanted to pursue such arrangements with commercial payers have encountered resistance, noted Frazier, who previously worked as a transformation manager at Geisinger Health System in central Pennsylvania. That resistance might be expected, considering the last half century of fee-for-service medicine and adversarial negotiations.
But a number of insurers see the future as one of collaboration, from the nonprofit Blues to national for-profits.
In greater Raleigh, Blue Cross and Blue Shield of North Carolina has inked a reimbursement contract with WakeMed Key Community Care, an Accountable Care Organization formed from a collaboration between WakeMed Health & Hospitals and Key Physicians. The partnership brings BCBSNC members a range of primary care-focused services, including chronic disease support, online communications and hospital and specialty care navigation, and is helping the health system scale and extend its participation in the Medicare Shared Savings Program. Various other Blue Cross companies are making inroads in value-based care, among them greater Philadelphia's Independence Blue Cross and Washington State's Regence Blue Shield.
On the national front, Aetna has its own internal ACO strategy that involves incentive alignment through revenue stability. As Charles Kennedy, MD, one of the architects of Aetna's accountable care strategy, said, "if you help the delivery system become more efficient, it may impact their bottom line in a negative way." Aetna calls its revenue stability program for providers "LEAP," the "Lasting Economic Advance Plan."
Meanwhile, Humana is working with Evolent and leveraging the consulting company's provider clientele.
Evolent's "payer value alliance" has three broad aims: aligned contract templates for creating and capturing value, establishing network of payer and provider relationships, and "built-for-purpose infrastructure including technological, financial and risk management, and population health platforms," the organization said.
"We're able to streamline the process of value-sharing contracting with these leading providers," said Renee Buckingham, Humana's enterprise vice president.
For health systems, according to Evolent's Frazier, opportunities vary across the country. In some regions they can set up long-term stable payer partnerships, while in other places they may be well-served by launching their own health plan, "but we don't see that as a necessary part" of population health, he said.
The goal in the end is for payers and providers to scale the population health model across commercial, Medicare and Medicaid patients, Frazier said. "The bigger the population the more delivery systems can drive investments and innovate around technology," such as expanded handheld ultrasound (convenient for quick diagnostics, increasingly preferred to scans with radiation and also less expensive) or mobile stroke units (an approach to rapid treatment that the Cleveland Clinic and UT Houston are pioneering).
More broadly, Frazier said, "We need to change the delivery of care" to one based on primary care, something more insurers seem to agree with, considering all the investment in patient-centered medical homes and related models. Today's "10 minute office visits don't have that capacity."