Managed Care

According to officials at CMS, December was the single largest monthly payout of EHR incentives in the program’s history. Roughly $1.2 billion went to eligible hospitals and eligible physicians in December, bringing the total estimated payout to $10.3 billion. The bulk of the payments went to EHs, who received $1 billion in Medicare and Medicaid incentive payments. EPs received $175 million in Medicare payments and $80 million in Medicaid payments.

Changes in the industry landscape are forcing health plan leaders to reevaluate their value proposition while continuing to execute effectively on these core competencies. There is additional pressure on health plans to now be the engine that seamlessly powers the all-important patient-provider relationship. This is the perfect time for a health plan to embark on a transformation of its core service model, thereby putting itself in a position to capitalize on the service expectations associated with the changing industry landscape.

After a win with the Atlantic City Special Care Center, the Cambridge Mass.-based Iora Health is replicating its care model of intensive primary care management services, aligned incentives, and actionable analytics, across the country. Iora Health's guiding principle is to target the small group of patients who generate the most healthcare costs, and treat them using a global budget, rather than fee-for-service infrastructure.

With its acquisition of the Bethesda, Maryland-based Coventry Health, the Hartford-based Aetna expands its “footprint” in the Medicare Advantage and Medicaid managed care markets, and unites two large health insurers for a total of nearly 42 million covered lives across the United States

The payer care management solution market is undergoing a transformation, reflecting the industry's drive toward value-based care, according to a new survey from the Framingham, Mass.-based IDC Health Insights. Providers would be wise take note of this development, as closer integration with health plans is expected in the new era of accountable care, which will rely heavily on core competencies more likely to have been mastered by payer organizations than by providers: population health and analytics.