WellPoint Inc. is pushing into the business of advising health-care providers, with a deal between the insurer’s CareMore unit and Emory Healthcare to jointly manage Medicare patients.
CareMore will collaborate with Emory to revamp the care of the Atlanta nonprofit’s private-plan Medicare patients, including people who will be covered by WellPoint’s Blue Cross & Blue Shield of Georgia and also rival health plans. CareMore executives will help run the new joint operation, and Emory doctors and other health-care providers will implement a version of CareMore’s clinical model.
CareMore operates a network of clinics and employs doctors, nurses and other clinicians who closely monitor patients, aiming to improve preventive care and avoid costly problems like emergency-room visits.
WellPoint Chief Executive Joseph R. Swedish, who took over last year after running a hospital company, has said the company will broadly be working more closely with health-care providers. He said WellPoint will also consider acquisitions that would add to its ability to forge such ties. “Strengthening our portfolio of these tools that can help providers seems very attractive, and certainly a strong position we’d want to establish in the marketplace,” he said.
The health-insurance industry has already been moving in this direction, including UnitedHealth Group Inc., with its huge Optum health-services arm, and Aetna Inc. Health plans see partnerships with health-care providers as a growth area as hospitals and physician groups increasingly turn toward forms of payment that involve taking on insurance-style risk. Insurers also hope to curb health-care costs with such arrangements.
The financial terms of the Emory tie-up, which initially will focus on about 7,500 Medicare beneficiaries projected to be enrolled starting in 2015, weren’t disclosed. Leeba Lessin, CareMore’s chief executive, said CareMore is supposed to share in savings the joint venture achieves. It is in talks with several other providers and aims eventually to have “dozens” of such deals, she said. WellPoint had previously said it was scaling back growth plans for CareMore’s own network of clinics amid changes in federal Medicare Advantage reimbursement.
Emory Healthcare Chief Executive John Fox said his system, which includes six hospitals and 1,800 doctors, is preparing to move away from traditional payments for each service toward setups where it is rewarded for reducing costs and improving quality. The CareMore deal is part of that effort, he said: “We are getting a one-way ticket to value-based contracting.”
Date: March 18, 2014