- UnitedHealth’s Optum unit and HealthBI have teamed up to help providers manage at-risk patients. The venture is aimed at boosting performance of Medicare Advantage plans.
- HealthBI’s software seeks to help providers identify members with access to actionable patient data and real-time patient status viewing.
- The platform pulls together data from a variety of sources including health plans, providers, pharmacies and health information exchanges.
One of the keys to succeeding with value-based payment models is identifying patients with the most complex and chronic conditions. They can benefit from coordinated care that avoids redundant procedures and follows up with treatment plans.
Part of Optum's business strategy is to align incentives of payers and providers to work in concert together to produce better clinical and financial outcomes.
HealthBI’s platform is currently deployed across over 63,000 clinical sites in 50 states. It has a 95% adoption rate.
The partnership shifts some risk to providers but banks on the ability to offer value to providers by giving them data they can use. The Scottsdale, AZ-based platform company said its tool can help manage complex populations, identify high-risk members and enable collaboration over care planning.
Providers seem to be warming to the idea of risk-based contracts, too. A recent AMGA survey of medical practices and health systems suggests nearly 60% of their Medicare revenues will be risk-based in 2019. Respondents also reported that MA revenues from risk-based payments will equal Medicare fee-for-service revenues next year.
Data and platforms will be big movements moving forward as providers and patients take on more financial risk in the healthcare system. Legacy electronic health record companies such as athenahealth, Allscripts and Cerner are exploring platforms in restructuring efforts. Companies like Vita Health, Omada Health and Flatiron Health have differentiated themselves in the market by focusing on data and therapeutics. Flatiron was recently acquired by Roche for $1.9 billion, a signal data is king in the new healthcare landscape.
CMS pays MA plans upfront for covering people with high healthcare costs. The agency recently proposed raising baseline MA rates an average of 1.84% in 2019. After accounting for the underlying coding trend’s impact on risk scores, payments will increase on average 3.1% next year.
Roughly a third of Medicare beneficiaries were enrolled in MA plans in 2017, versus one-fourth just six years ago. From 2016 to last year, enrollment grew 8%, and CMS has said membership will grow an additional 9% to 20.4 million this year.