News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel

News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
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Payer-Provider Partnerships Accelerating as Insurers and Healthcare Networks Look to Improve Care Quality and Reduce Costs

Shift from fee-for-service to value-based reimbursement is fueling increase in joint ventures and co-branded insurance products, creating opportunities for nimble clinical laboratories and anatomic pathology groups

As healthcare moves from fee-for-service to value-based reimbursement, health insurers and providers are joining forces at a steadily increasing rate, with nearly three-quarters of partnered products in early 2018 being joint ventures or fully co-branded insurance products. This trend presents an opportunity for clinical laboratories to help providers become more effective in their use of laboratory tests as they aim for better patient outcomes and lower treatment costs.

While health systems integrating with insurance services is not new, the roll out of the Affordable Care Act (ACA) in 2014 and its emphasis on value-based reimbursement helped create renewed interest in vertical integration, notes Becker’s Hospital Review.

According to consulting firm Oliver Wyman, the number of payer-provider partnerships has grown rapidly over the past six years, with 73% of the 22 insurance products launched in the first quarter of 2018 being joint ventures of co-branded offerings.

In comparison:

  • 22% of partnerships were joint ventures or co-branded in 2014:
  • 33% in 2015;
  • 57% in 2016; and,
  • 71% last year.

Of the 22 new payer-provider partnerships announced this year, 20 product announcements explicitly emphasized value-based compensation, while compensation was implied but not mentioned in the final two product-based partnerships.

“Payers and providers continue to be interested in forming product-based partnerships,” Oliver Wyman stated when releasing the new data. “Our analysis … continues to show a steady increase of trend toward deeper partnership, with more co-branding, greater levels of value-based financial alignment, and other forms of closer collaboration and joint ventures.”

Oliver Wyman cited several “notable” new entrants:

In addition, Oliver Wyman noted that national payers Aetna and Cigna added to their growing rosters of joint ventures in 2018.

Speaking with Healthcare Dive, Tom Robinson, Partner, Health and Life Sciences at Oliver Wyman, described this year’s new ventures as varying in type, size, location, and model. He noted that 50/50 joint ventures with co-branding have gained in popularity, however, accountable care organizations (ACOs), pay-for-performance, and bundled-payment models also are being formed. Robinson believes these vertical integrations offer opportunities for innovation.

“The point of these partnerships is to create something new, rather than just building the same old offerings with a narrow network,” Robinson said. “Successful partnerships will take the opportunity to innovate around the product and experience now that the incentives, insight, investment and integration are all for it.”

Oliver Wyman Health and Life Sciences Partner Tom Robinson discusses the emerging trend of payer-provider partnerships

In the video above, Oliver Wyman Health and Life Sciences Partner Tom Robinson discusses the emerging trend of payer-provider partnerships, and he highlights unique challenges and opportunities of these joint ventures. Click here to watch the video. (Photo and caption copyright: Oliver Wyman.)

Lower Costs, Improved Access, Through Payer-Provider Partnerships

In announcing Blue Cross Blue Shield of Rhode Island (BCBSRI), and Lifespan’s launch of coordinated healthcare plan BlueCHiP Direct Advance, BCBSRI President and Chief Executive Kim Keck pointed to the plan’s ability to drive down healthcare costs.

“We hear a consistent theme from our members—they want more affordable health plan options—and through our collaboration with Lifespan we are doing that,” Keck stated in a news release. “BlueCHiP Direct Advance is an innovative product that features Lifespan’s vast network of providers who are positioned to more effectively manage and coordinate a patient’s care. And, our partnership allows us to offer this new product at a cost that is 10% lower than our comparable plans.”

When Allina Health System of Minnesota and Aetna last year announced their partnership plans, Allina Chief Executive Penny Wheeler, MD, praised the ability of “payer-provider” partnerships to improve care coordination and increase access to preventive care.

Jim Schowalter, MPP, President and Chief of Executive of the Minnesota Council of Health Plans, told the Star Tribune the joint venture between the for-profit insurer and local health system would accelerate the shift within the state to value-based care.

“This is another effort in our state that moves us away from old fee-for-service systems,” Schowalter stated. “Working together, doctors and insurers can deliver better personal care and hold down medical expenses.”

While the future of the ACA and other healthcare reforms is uncertain, clinical laboratories and anatomic pathology groups should expect healthcare networks and insurers to continue to find ways of partnering. That means pathologists can expect to have an expanded role in helping providers improve patient outcomes and reduce healthcare spending.

—Andrea Downing Peck

Related Information:

Analysis: Payers and Providers Continue to Partner

Providers Becoming Payors: Should Hospitals Start Their Own Health Plans?

Payer-provider Partnerships on Record Pace

Blue Cross and Blue Shield of Rhode Island and Lifespan Partner to Bring Lower Cost Option to Rhode Island Residents in 2018

Security Health Plan Adds Mayo Clinic Health System to Provider Network

New Partnership Expands WellCare Members’ Access to UNC Health Alliance

Allina Health and Aetna to Launch Insurance Company in Minnesota

Experts Say Medicare Accountable Care Organizations (ACOs) Produced Mixed Results in 2014 Even as Enrollment Continues to Grow Significantly

Clinical laboratories and pathology groups can expect to see more growth in the number of patients served by ACOs and that will require labs to have a new pricing strategy

Will ACOs be the next big thing in American healthcare? Many people are betting that will be true as the number of ACOs continues to increase. Some reports indicate that as many as 750 Medicare and private ACOs were in operation as of early 2015, compared to about 250 ACOs in 2013.

Pathologists and clinical laboratory managers watching the ACO trend will find it significant that Medicare ACOs now serve about 5.6 million beneficiaries. According to a report issued by Oliver Wyman, that is about 11% of all Medicare beneficiaries. Providers in these ACOs are paid under a different arrangement than the long-established Part B fee-for-service price schedule.

The big question mark about ACOs is whether they can deliver significant cost savings while improving patient outcomes. This summer, officials at the federal Centers for Medicare & Medicaid Services (CMS) reported on the savings generated by the agency’s pilot ACO programs. The two main accountable care organization programs are the Medicare Shared Savings Program (MSSP) and the Pioneer ACO Program. (more…)

Ranking of Nation’s 15 Biggest Accountable Care Organizations (ACOs) Shows Fast Growth of this Model of Integrated Clinical Care

Across the nation, as many as 500 ACOs are organizing or already delivering clinical services to as many as 43 million Americans

There is no better way to track the progress of accountable care organizations (ACOs) than to monitor a list of the largest ACOs in the United States. Many pathologists and clinical laboratory managers already serve patients who are enrolled in ACOs.

Oliver Wyman, a consulting firm headquartered in New York City, is tracking the development of ACOs in different regions of the nation. It recently published the statistics on the number of ACOs and estimated ACO enrollment.