UnitedHealthcare and Oak Street Health announced they are establishing a value-based initiative for Medicare Advantage (MA) patients in 14 primary care centers in Illinois and two northwestern Indiana locations.
About 20,000 MA enrollees in UnitedHealthcare plans in the greater Chicago area will have access to Oak Street Health.
The two companies said a key part of the program will be the payer sharing data with Oak Street Health “to inform doctors of patients’ underlying medical conditions, past treatments, gaps in care, medications prescribed and future care needs.”
The initiative will allow UnitedHealthcare and Oak Street Health, which offers community healthcare centers that promotes value-based health and wellness, especially for Medicare beneficiaries in medically underserved communities, to “identify clear, actionable information specific to individual patients’ health needs.” That includes identifying high-risk patients, helping manage their chronic health conditions, effectively managing their medication needs and reducing emergency room visits and hospitals re-admissions.
UnitedHealthcare is the number one MA payer with about one-quarter of the market. Much like other payers, UnitedHealthcare is moving more contracts from fee-for-service to value-based care both in the employer-based and MA markets. UnitedHealthcare tripled its value-based arrangements with providers and hospitals over the last three years. UnitedHealthcare has made more than $54 billion in value-based payments this year and expects that will increase to $65 billion by the end of next year.
More payers are moving into value-based partnerships with providers. They vary by type based on risk, including 50/50 joint ventures with co-branding, accountable care organizations and bundled payments. They all seek the same results — improving quality, increasing data flow between partners and lowering healthcare costs.
Fred Bentley, vice president at Avalere, recently told Healthcare Dive that providers and payers are more focused on managing patients’ health rather than volume. Bentley expects these kinds of experiments and partnerships will increase in the coming years and will increasingly blur the lines between payers and providers.
You can expect more of these partnerships in the MA population as payers continue to view that market positively. One-third of Medicare beneficiaries are enrolled in an MA plan this year compared to 25% just six years ago. Enrollment grew by 8% between 2016 and 2017 and the CMS recently announced that MA membership will grow by 9% to 20.4 million members in 2018.
Steve Wiggins, founder and chairman of Remedy Partners, recently told Healthcare Dive that growth isn't expected to slow. “With Republican control of the federal government, it is conceivable that Medicare Advantage will become a centerpiece of CMS’ strategy to control spending growth,” said Wiggins.