Managed Care - August 2012 - (Page 24)

that are forward-thinking. “Our approach is to physician practices and aligning with physicians.” work with developing ACOs in three ways. We can Jeff Goldsmith, PhD, CEO of Health Futures, make a contribution in key areas where hospital or says, “Private practice as an institution is in deep physician-centric ACOs are lacking and where we trouble and needs renovating. Physicians are being have true expertise. hit with significant payment cuts, more so than any “One way is to deploy information technology other provider, and private practice will survive which helps providers transform into only if organized into viable economic an ACO,” Kennedy continues. “The units that can also deal with the complexity of providing care.” second way is through a collaborative care program for working with target Some health plans are adopting populations like Medicare Advantage strategies to support physician pracmembers or employer groups, and the tices, either in reforming their procethird way is to help the delivery system dures or in countering the incentive develop its own private label health to give up private practice and go to plan in preparation for insurance exwork for a hospital. changes.” WellPoint is committed to investAetna’s ACOs with Inova Health “Health plans can get involved in ing an additional $1 billion in primary and Aurora Health Care include health managing physician practices and care fees. Doctors can earn additional plans with innovative benefits and net- aligning with physicians,” says revenue in the form of an increase in works that cost less. This is a dramatic Steve Shortell, PhD. regular payment rates, of payment for step beyond shared-savings ACOs and nonvisit services such as preparation of most risk-based HMOs. It implies a long-term recare plans, and through shared savings arrangelationship and moving beyond alignment into inments. In 2010, Independence Blue Cross raised its tegration. maximum incentive payments to allow doubling Experts also say that ACOs are not feasible of base payment rates. in every market and other health plan/provider In February, Highmark Blue Cross created alignment strategies will have to be developed to ProMed XChange to provide practice managemove toward coordinated care and population ment services to independent private practices. health management and move away from fee-forThis move is not related to ACO development; it service payment. is a response to the market clout of the University “Things are moving to a population-based payof Pittsburgh Medical Center and its health plan. ment methodology that is going to be driven by In California, UnitedHealthcare’s practice manthe ability to manage outcomes,” says Anthony agement services organization, Optum, acquired D’Eredita, an executive vice president at the the assets of a 2,300-doctor group and two smaller Advisory Board, a health care consulting comgroups. pany. “We have to redefine provider economics in King primary care relation to that care delivery model, which largely means pushing care from inpatient to outpatient These moves underscore the growing importance services — and physicians are key to that.” of doctors in the new era, especially primary care Experts say that health plans need to support physicians, who “will play a much larger role under physician practices as a general strategy to promote population health management and ACOs, much positive reforms and to avoid the various negative as they did in the ’90s,” says Paul Ginsburg PhD, effects of hospital-physician alignment. president of the Center for Studying Health System “There is no question that physicians need to Change. “Since PCPs don’t practice in the hospital, advance to more efficient and organized delivery of there was no reason to employ them, but if hospitals services, and that means we need to have physicians will be responsible for services delivered outside the practicing in larger groups that can coordinate inpatient setting, then they need to work closely care,” says Steve Shortell, PhD, dean of the Uniwith these physicians.” versity of California–Berkeley’s School of Public D’Eredita agrees. “The employment race is on in Health. “Health plans can get involved in managing primary care.” To date, realignment has primar- 24 MANAGED CARE / AUGUST 2012

Table of Contents for the Digital Edition of Managed Care - August 2012

Managed Care - August 2012
Editor’s Memo
Contents
Legislation & Regulation
News & Commentary
Medication Management
Evidence Review
Compensation Monitor
Private Exchanges: Practice Makes Perfect
Hospitals and Providers Ganging Up on Plans?
Q&A: Kaiser Permanente’s Sharon Levine, MD
God Save the Health Care System!
Future Points to Greater PBM/Plan Cooperation
Formulary Files
Plan Watch
Tomorrow’s Medicine
Outlook

Managed Care - August 2012