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The Push Towards Value-Based Care Is Forcing the HIT Vendor Market Forward

June 4, 2018
by Heather Landi
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When it comes to meeting providers’ needs and offering the IT capabilities required to support value-based care, experts say there is much work that still needs to be done
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The healthcare policy and payment landscape is rapidly evolving, with the move to value-based care models a driving force behind current healthcare reform efforts. Case in point: in a recent speech at the World Health Care Congress, Health and Human Services (HHS) Secretary Alex Azar laid out his agency’s overall policy strategy and cited accelerating the value-based transformation of the healthcare system as a top priority.

In this landscape, healthcare provider organizations across the country are advancing forward with population health management, accountable care organization (ACO) development, bundled payments and interoperability initiatives that require robust data and analytics capabilities.

This ongoing evolution is, in turn, fueling healthcare providers’ demands on healthcare IT vendors to provide solutions and capabilities to fit their needs for population health management and value-based care models, with core IT capabilities needed around data aggregation, data analytics, care management and patient engagement, to name a few.

Facing these health IT demands, the major electronic health record (EHR) vendors have built out their own population health and analytics capabilities, such as Cerner’s HealtheIntent platform, Epic’s Healthy Planet and athenahealth’s Population Health platform. According to many healthcare IT experts, EHR vendors are making inroads in the PHM space and are challenging some of the best-of-breed vendors.

Liam Bouchier

“About five years ago, there were maybe between 15 to 20 population health tool vendors in the market, but the major EHR vendors were not interested in that space, and that has changed dramatically with the large EHR systems in the past five years, Epic in particular,” Liam Bouchier, principal at healthcare IT consulting firm Impact Advisors, says. “Epic, at this point, is Best in KLAS for their tool set that they provide. Another major competitor, Cerner, also has an incredibly powerful platform. Are these platforms perfect? No. Why? The main reason is, beyond the structured information that you get from health systems, approximately 40 percent of health outcomes are determined by your behaviors, and that’s really where the gold is in terms of data that is needed to drive some of these health outcomes in a positive fashion,” Bouchier says.

A Booming Health IT M&A Market

The evolving payment and policy landscape, shaped in many ways by the drive towards value-based care models, is also driving developments in the health IT mergers and acquisitions (M&A) landscape.

A recent white paper by Berkery Noyes, a New York City-based independent investment bank that provides M&A advisory and financial consulting services, notes that the healthcare technology industry is undergoing a rapid transformation and structural shifts due to reform, cost pressures, and shifting responsibilities between payers and providers. “Private, best-of-breed technology-enabled healthcare IT companies that effectively address market niches and have some level of scale are in high demand by both financial and strategic buyers,” the report states.

The white paper, which examines activity in the pharma and healthcare information and technology M&A trends over the past two years, notes that the breadth of acquirers for healthcare IT companies continues to expand as buyers look to capitalize on the size, rapidly evolving dynamics and growth characteristics of the healthcare market. Acquirers are aggressively looking to broaden product suites, leverage distribution channels, and realize revenue and cost synergies, according to the report, also noting that M&A-driven expansion of strategic healthcare technology platforms is a dominant trend.

According to Berkery Noyes, there were 922 industry M&A transactions from the beginning of 2016 through the end of 2017. Among these deals in the past two years, enterprise value multiples have been strong, with deals averaging about 2.1x revenues and with a median EBITDA (earnings before interest, tax, depreciation and amortization) multiple of 12.5x in 2016 and growing to 13.2x in 2017.

“There’s a boom time in healthcare IT M&A. It’s a great time to be a seller if you have a growth company of scale in healthcare today,” Thomas O’Connor, managing director, healthcare investment banking at Berkery Noyes, says. “The market right now for a recurring revenue growth business of scale is unbelievable. We’re very deep in an M&A cycle; there’s $1.2 trillion of private equity money chasing deals, they can’t find deals of scale and it’s come way downstream in the marketplace today. Most of the deals you’ll see are add-ons to the portfolio companies.”

Thomas O'Connor

The healthcare technology space continues to be tremendously attractive to investors, O’Connor says, because there are significant opportunities going forward. “There’s lots of niches where there are opportunities to solve pain points along the healthcare continuum. You see that in the marketplace; there are a tremendous amount of companies on the market right now,” he says.

Due to large macro/regulatory changes in healthcare and a massive shift to electronic solutions, there is a very favorable climate for sellers with unique offerings, scale, recurring revenue models and rapid growth in attractive niches, including patient engagement, population health and related data analytics, treatment plan adherence, mobile solutions, and regulatory compliance, the Berkery Noyes report states.

These trends are evident in the population health-related activity seen in the market in the past few years. In August, NextGen Healthcare Information Systems acquired EagleDream Health, a cloud-based, value-based care analytics platform. Back in July 2016, Philips acquired Wellcentive for $165 million and also purchased another population health vendor, VitalHealth, last year. athenahealth also expanded its population health portfolio with its $15 million purchase of care coordination vendor, Filament Labs (dba Patient IO). Another population health transaction of note was GE Healthcare’s purchase of the balance of Caradigm from Microsoft. And, IBM has made significant moves in this space, buying Truven, a payer solution, for $2.6 billion, which followed its acquisitions of Explorys, an integration and big data platform;  Phytel, a population health vendor; and Merge.

From an investment and M&A perspective, all this activity adds up to a robust health IT vendor market. However, there are indicators that when it comes to meeting providers’ needs and offering the IT capabilities required to support value-based care, there is much work that still needs to be done.

Are IT Vendors Hitting the Mark?

Many healthcare IT leaders at patient care organizations contend that there are still significant gaps in the capabilities and functionalities of population health management tools on the market today, and many hospitals and health systems use multiple population health solutions working in tandem.

“There is no one vendor that does everything in population health. Nobody has hit the mark yet, as to a solution that delivers everything,” Bradley Hunter, research director, population health at KLAS Research, says. “That being said, everybody is improving and investing a lot in this, and we hear about that from providers. The EHR vendors, they know that there’s a lot of functionality that they can offer that will be helpful to their clients, and they are working on developing that.”

Bradley Hunter

Provider organizations’ needs in managing population health, a key part of value-based care, are as varied as the capabilities of the IT solutions designed to assist them, according to a KLAS report on the population health management market. New vendors have emerged, and longstanding vendors are evolving, resulting in a diverse array of technologies that may address one or all of the different areas of value-based care, such as data aggregation, data analytics and care management, says Hunter.

 “I think the best of the vendors are making real solid progress in these areas, but this has been a space with a lot of different vendors, not just EHR vendors, but other niche players also have rushed into the marketplace, so it can get kind of confusing as to who is doing what and who is good at what,” says George Reynolds, M.D., a retired healthcare CIO and chief medical information officer (CMIO) and currently principal of Reynolds Healthcare Advisors, based in Omaha, Nebraska. He adds, “As far as population health, what parts are you going to look at? Are you just looking at data aggregation and how you’re presenting the analytics of a population of patients? Or are you looking at patient engagement tools? Those are very different ends of a spectrum that wraps into the idea of value-based care, and different players have different strengths in those spaces.”

A survey of healthcare executive leaders conducted by Sage Growth Partners, a Baltimore-based business management consulting firm, found that two-thirds of respondents say EHRs have failed to deliver better population health management tools, and about half claim they would be willing to switch EHRs to get these capabilities. The survey also found that, by and large, providers’ value-based care needs are not being met. Sixty-four percent of providers said EHRs have failed to deliver many critical value-based care tools. Only a quarter of respondents believe that their EHR can deliver on core KLAS criteria for value-based care. And 60 to 75 percent of providers are seeking third-party solutions outside their EHR for value-based care solutions.

“The EHR vendors are certainly players and they need to be a part of your tool set, but you need interoperability components, and you need patient portal components, from a patient engagement perspective,” Chuck Podesta, CIO at the University of California Irvine Health, says. “You see a lot of niche vendors out there in each of their areas, and it makes it tough for CIOs, because we have to cobble things together based on the needs of the organization, rather than relying on one or two of our partner vendors that we already work with, to solve the problem for us.”

Finding solutions with the analytics capabilities required for value-based care is particularly challenging, Podesta says. “There really hasn’t been a single company to figure that out. They are all trying to move in that direction, such as Epic with Caboodle and Healthy Planet, and Cerner has some things it pushes on population health as well, but neither one has really come up with all the various parts and pieces that you need,” he says, adding, “Similar to what you would have in an EHR for an organization, you’re looking for that type of single vendor approach, and in population health you’re not going to find it. A lot of it is because the analytics side hasn’t matured enough in these companies yet to call them a one-stop solution for value-based care.”

Chuck Podesta

Podesta also points out that in the past, health IT vendors have pivoted to keep up with policy and payment changes, such as the passage of the American Reinvestment and Recovery Act (ARRA) in 2009, which included the Health Information Technology for Economic and Clinical Health (HITECH) Act and the advent of the meaningful use program.

“Everyone realized you needed a single system that had all the functions and features integrated, so you could pull all the information together from a meaningful use perspective. Now, with value-based care, we really don’t have that. We have all these best-of-breed solutions right now. Just like we chose one solution to solve MU for us, it would be nice to choose one solution that would solve value-based care. But, the value-based care side is more complex that meaningful use ever was; it’s going to be awhile before you see one vendor come to the forefront that has an end-to-end solution,” Podesta says.

Larry Kocot, a principal at New York City-based advisory services firm KPMG and also national leader of the firm’s Center for Healthcare Regulatory Insight, says, “I think vendors are trying to go directionally where providers need them to go, but, in defense of the vendors, the transition is not smooth and frankly, it’s not uniform. Vendors are in a difficult spot trying to match the needs of a community that is in transition, and there’s no homogeneity across the country in terms of where physicians are on this journey. You can either get out in front of them and give them more capabilities than they need, or you can lag behind in what they want.”

Ralph Fargnoli, managing director, advisory at KPMG, notes that population health and analytics tools are evolving, and he sees vendors’ capabilities improving. With population health efforts, he says, the end-state goal is for providers to have a complete picture of a patient, including social and environmental factors: “We’re still years away from having that capability. We can see what we need; we’re getting a much clearer vision of where we need to go, but we’re still in an evolution.”

A Shifting Vendor Market, and Potential Collaborations

The sea of changes occurring in healthcare have already significantly impacted the vendor market and more changes are on the horizon, many healthcare IT experts say. 

Reynolds says, “One of the universal truths of the big players, the major EHR vendors, is that the burden on the customer, the cost of moving away from a given vendor, is quite substantial. Historically, that has been the case that once you’ve signed on with them, it costs too much to change. I’ve been hearing that most of my career in health IT. Yet during that time, I’ve seen the top vendors of five to seven years ago being acquired or getting out of the market entirely and vendors that were not at the top of the food chain back in 2002 to 2010, are now at the top of the food chain. It would suggest that there is going to continue to be significant change.”

George Reynolds, M.D.

He continues, “Now where is that change going to come from? Someone might ask, will Cerner or Allscripts be going out of business in 10 years? I doubt it, but they may be in a very different business, in terms of how they provide that service, how modular that service is. Is it a menu system, is it all cloud-based? They are either going to adapt, get acquired by someone else or go out of business because the market is going to continue to drive change.”

And, Podesta notes, there continues to be some uncertainty around the Trump administration’s plans for healthcare reform and the administration’s continued interest in dismantling the Affordable Care Act, which has implications for the healthcare IT market. “We’re in a bit of a stagnation period if you’re looking towards the future. A lot of venture capital companies that are investing in these startups to fill some of these niches are struggling with the idea, is this where value-based care is going? Is this where care is going in the U.S.? That’s one side of it. The other side is you’re seeing a lot of players that typically weren’t in the healthcare market moving in rapidly, such as Amazon, Google and Apple, and all these large organizations have a lot of money to spend.”

Many of these companies, through their public cloud offerings, are already working with health IT vendors, such Epic’s partnership with Microsoft Azure and Amazon collaborating with Cerner to use its cloud service, AWS, for Cerner’s HealtheIntent platform. “He who owns the data, wins, when it comes to value-based care and if they can be the aggregator and do something with it, that’s very powerful. I think that’s what you’re going to see from them,” Podesta says.

“It’s hard to say how all of that is going to play out. I think what you’re going to see is a lot of organizations joining forces and picking solutions together rather than just going forward by ourselves, with consortiums starting to happen as well. Everybody is trying to come up with what they think the solutions might be going forward and it’s fascinating watching it play out,” he notes.

Bouchier with Impact Advisors sees an interesting intersection between the entrance of new disruptors in healthcare and the evolving healthcare reform efforts. “The policy and payment landscape is changing the paradigm of how care is delivered. It’s not a fee-for-service model anymore, it’s about the quality of care that is being delivered, and part of the metrics being tracked are about the patient experience and the patient satisfaction with the service that’s being offered. The starting point for that is already there.”

Companies like Apple and Google will change how healthcare information is delivered to patients and consumers, making it more convenient and efficient, Bouchier says, although he doesn’t see those big technology companies going into the EHR market. “The lift to do what EHR vendors do today is challenging. There’s always the possibility that another big EHR vendor will come along. But, I think that everybody is coming to the table with their capabilities, Amazon, Microsoft, Apple, and Google. They know what their strengths are and won’t deviate beyond that. It’s going to be more about partnerships, and leveraging strong partnerships, to attract a patient population,” he says.


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Should Physicians and HIT Leaders Worry about the Implications of the Walgreens/Microsoft Deal?

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As architect Daniel Burnham once said, “Make no little plans”; the leaders of the Walgreens/Microsoft alliance, like so many others, certainly are thinking big these days
architect Daniel Burnham

Nearly every day, it seems, new business combinations are announced that are threatening to alter the landscape of U.S. healthcare forever. CVS’s acquisition of Aetna, completed last November; the announcement a year ago now that the executives of Amazon, Berkshire Hathaway, and JPMorgan Chase & Co. were launching a broad (if not well defined) initiative to improve consumer satisfaction and reduce costs for their employees; Cigna’s acquisition just last month of pharmacy benefit management (PBM) company Express Scripts; and Amazon’s acquisition last summer of online pharmacy company PillPack.

Every one of those business deals represents a disruptive move in U.S. healthcare, with unalike “species” of organizations combining with one another. And now, the retail drugstore giant  Walgreens Boots Alliance Inc. and Microsoft Corp. are coming together in yet another disruptive venture. As Managing Editor Rajiv Leventhal wrote in an article on Tuesday, the corporations “are joining forces on a major seven-year healthcare partnership that will aim to ‘deliver innovative platforms that enable next-generation health networks, integrated digital-physical experiences and care management solutions.’” As he wrote, “The companies announced today that they will combine the power of Microsoft Azure, Microsoft’s cloud and AI (artificial intelligence) platform, healthcare investments, and new retail solutions with WBA’s customer reach, volume of locations, and outpatient healthcare services to accomplish their goals: to make healthcare delivery more personal, affordable and accessible.”

As Leventhal noted in his report, “While innovation in healthcare has occurred in pockets, officials of the two companies believe that ‘there is both a need and an opportunity to fully integrate the system, ultimately making healthcare more convenient to people through data-driven insights.’” Further, he noted, “As part of the strategic partnership, the companies have committed to a multiyear research and development (R&D) investment to build healthcare solutions, improve health outcomes and lower the cost of care. This investment will include funding, subject-matter experts, technology and tools, officials noted in the announcement. The companies will also explore the potential to establish joint innovation centers in key markets. Additionally, this year, WBA will pilot up to 12 store-in-store ‘digital health corners” aimed at the merchandising and sale of select healthcare-related hardware and devices.

“This gap creates an opportunity for the pharmacist to help monitor the patients’ health and prompt the patient to receive preventative care in the retail clinic or through a virtual care visit. Using an enterprise health cloud, like Azure, you create a more connected ecosystem so that we can share that data with the patient’s additional providers, track outcomes, and intervene earlier when an issue arises,” Microsoft CEO Satya Nadella said in a statement Tuesday.

And, Leventhal wrote, “Notably, the companies will also work on building an ecosystem of participating organizations to better connect consumers, providers—including Walgreens and Boots pharmacists—so that major healthcare delivery network participation will provide the opportunity for people to seamlessly engage in WBA healthcare solutions and acute care providers all within a single platform.”

Speaking to the difference between retail pharmacies and traditional care providers, Forrester analyst Arielle Trzcinski said in a statement emailed to the press that “[R]etail pharmacies offer an opportunity to engage with the patient much more frequently than at an office visit, giving an example of how chronic care patients see their pharmacist frequently, while some figures indicate that the average diabetic patient sees his or her provider once every six months.”

The implications of all of this are, of course, huge. For one thing, if one were to ask the average patient/healthcare consumer with whom they interacted more, doubtless, the vast majority would cite their retail pharmacists, rather than their primary care physicians. What’s more, what happens if Walgreens is able to follow through, as CVS also intends to do, in creating minute clinics in retail pharmacy locations? The impact could be revolutionary.

Indeed, it’s no secret that many patients are dissatisfied with the cumbersome, challenging processes around accessing primary and specialty care in the U.S. healthcare system. Simply accessing a timely appointment often proves to be a major hassle; and encounters around needed follow-ups and around questions to doctors and nurses often turn out to be such a hassle that many patients simply give up, with the result of medication non-compliance and other issues.

So what will happen if Walgreens, like CVS, manages to achieve success with one or more elements of this initiative? Those could include enhanced continuum of care for patients, especially those with chronic diseases; improved communication among all care delivery stakeholders; and enhanced patient/consumer satisfaction.

A few stakeholder groups should be paying particular attention here, including practicing physicians and healthcare IT leaders. For practicing physicians, could anyone deny that this business initiative, along with the others mentioned above, should be disconcerting at the very least? Already, patients needing relatively immediate medical attention, are turning en masse to urgent care centers, as both health systems and health insurers are working to cut down on the volume of emergency department visits, which are tremendously expensive, and which burden the healthcare delivery system in ways that are not sustainable. But now, with both Walgreens/Microsoft and CVS/Aetna, is anyone denying that the era of pretty-close-to-immediate medical attention is on the horizon?

The reality is that, while most patients like their primary care physicians and are satisfied with their care overall, strong majorities, in polls, continue to complain about poor service, bad communication, and delays accessing care and accessing follow-up support. What happens when most decent-sized Walgreens and CVS drugstores are staffed up with PCPs or advanced practice nurses, to handle the colds, coughs, flus, strep throats, and minor skin and digestive issues that could easily be handled by such service offerings?

One of the core policy issues here is that the U.S. healthcare payment system remains largely predicated on primary care physicians physically touching patients in order to get paid. Yes, telehealth services are expanding daily; but in most situations, patients still need to go through the awkward, inconvenient, sometimes even-arduous process of scheduling an appointment, using some form of transportation to get to that appointment, and waiting in a crowded physician office, in order to access primary care.  But in 2019, when GrubHub can deliver one’s banh mi Vietnamese sandwich to one’s home, and Amazon is sending everything from books to clothing to furniture to God-knows what, directly to people’s doors, how much longer will healthcare consumers continue to be patient with the glacial pace of care delivery change in U.S. healthcare?

Meanwhile, healthcare IT leaders will inevitably find themselves somewhat behind a proverbial eight-ball on all this, caught between the intensifying demands on the part of practicing physicians, especially primary care physicians, for full clinical IT support for their practices, and constant business changes, including merger-and-acquisition activity in their own organizations that is continuously scrambling their long-term planning.

So we’re seeing both business and technology changing, and changing quickly, with numerous examples already of industry-disruptive business combinations, and technology advancing to the point where previously unimagined breakthroughs are now imaginable. For example, Walgreens and Microsoft noted that, “Through this agreement, Microsoft becomes WBA’s strategic cloud provider, and WBA plans to migrate the majority of the company’s IT infrastructure onto Microsoft Azure,” as corporate officials put it. And “Microsoft also plans to roll out Microsoft 365 to more than 380,000 Walgreens employees and stores globally.” And, to make things just that more intriguing, the announcement quoted Stefano Pessina, executive vice chairman and CEO of the Walgreens corporation, as stating that “WBA will work with Microsoft to harness the information that exists between payors and healthcare providers to leverage, in the interest of patients and with their consent, our extraordinary network of accessible and convenient locations to deliver new innovations, greater value and better health outcomes in health care systems across the world.”

As renowned Chicago architect Daniel Burnham so famously said, “Make no little plans; they have no magic to stir men's blood and probably themselves will not be realized.” There’s no question that the senior leaders of all of these business alliances, combinations, and initiatives are going to be “no little plans.” It would behoove clinicians, clinician leaders, healthcare IT leaders, and all c-suite leaders in provider organizations to think Burnham-sized thoughts; these businesspeople from outside traditional healthcare delivery are certainly doing so.

 

 

 

 

 

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Blue Cross NC, Five Health Systems Announce Major Shift to Value-Based Care

January 16, 2019
by Heather Landi, Associate Editor
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The insurer aims to have half of its 3.89M customers covered by VBC contracts by next year; all customers in VBC arrangements in five years
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Blue Cross and Blue Shield of North Carolina (Blue Cross NC), one of the state’s largest insurers, and five of the state’s major health systems in North Carolina have announced a new value-based care program that encompasses hundreds of thousands of healthcare customers throughout the state.

The five health systems—Cone Health, Duke University Health System, UNC Health Care, Wake Forest Baptist Health and WakeMed Health & Hospitals—and their accountable care organizations (ACOs) have committed to participating in Blue Premier, a new value-based model of care in which Blue Cross NC and the health systems will be jointly responsible for better health outcomes, exceptional patient experience and lower costs, according to a Blue Cross NC press release.

“With agreements from five of the state’s major health systems and their ACOs, Blue Premier is one of the most rapid and comprehensive shifts to value-based payments in the nation,” Blue Cross NC officials stated. Patrick Conway, M.D., serves as president and CEO of the Durham-based health insurer and previously served as the Chief Medical Officer, Deputy Administrator, and Director of the Center for Medicare and Medicaid Innovation (CMMI), a division of the Centers for Medicare and Medicaid Services (CMS).

Within five years, Blue Cross NC has committed to having all 3.89 million customers covered under Blue Premier’s value-based care contracts. By early 2020, fifty percent or more of all Blue Cross NC members will have a provider who is jointly responsible for the quality and total cost of their care, the health insurer stated.

“As a practicing physician, I have experienced first-hand the challenges plaguing our health care system,” Conway said in a statement. “Historically, our health care system pays for services that may or may not improve a patient’s health, and our customers simply cannot afford this approach. Moving forward, insurers, doctors and hospitals must work together, and hold each other accountable for improving care and reducing costs. We applaud the leadership and commitment of these five leaders in health care to help transform health care delivery in North Carolina.”

During the HLTH Conference, held at the Aria Resort in Las Vegas last May, Conway discussed the payer-provided landscape in North Carolina and alluded to opportunities accelerate the move to value-based care and payment models, according to reporting from Editor-in-Chief Mark Hagland. “We’re looking at a new model, where patient care organizations can partner more fully with Blue Cross North Carolina,” Conway said, per Hagland’s report. And Conway continued, “We’re saying, you can take this alternative pathway with us. And we’ll jointly be accountable for the total quality and cost of care. And we want you to go into two-sided risk. And we’re wondering, should we turn off all prior authorization? And documentation other than for risk coding and STARS measures, we won’t worry about how you document. And for people in the audience, those kinds of partnerships are very exciting, because you’ve now got a provider and payer that are no longer locked into rigid rules, but where you can innovate on quality and customer experience.”

According to the insurer, Blue Premier ties payments to doctors and hospitals over time to the value of services that improve patient health. This means that total payments to the health systems under Blue Premier will be based on the health systems’ ability to manage the total cost of care and their overall performance, measured by industry quality standards. Through a “shared risk” financial model, the health systems will share in cost savings if they meet industry-standard goals to improve the health of patients – and share in the losses if they fall short. “The unprecedented commitment from these five large health systems makes Blue Premier one of the most advanced and comprehensive value-based care programs in North Carolina and the nation,” Blue Cross NC officials stated.

“This unprecedented step by Blue Cross NC and many of the state’s leading health care organizations will make a big difference in advancing high-quality, innovative care in North Carolina,” Mark McClellan, M.D., Ph.D., director of the Duke-Margolis Center for Health Policy said in a statement in the press release. “At Duke-Margolis, we remain committed to supporting state government and private-sector initiatives to reform payment and improve care – providing needed examples for the nation.” 

In a statement, Donald Gintzig, president and CEO, WakeMed Health & Hospitals, said, “This collaboration represents an important step forward in our efforts to provide patients in our area and across the state with high quality, coordinated services for the best value. Our health systems are bringing together valuable resources in a more integrated way that will ultimately lead to better health and more affordable health care.”

The news of the value-based care collaboration comes a month after the health insurer announced a partnership with Aledade, a Bethesda, Md.-based company focused on physician-led ACO development, to launch a value-based care initiative to support primary care physicians across the state. Through the initiative, the two companies will support physician-led ACOs tailored specifically for primary care physicians and the communities they serve. Through these ACO arrangements, Blue Cross NC will collaborate with Aledade to provide physicians with technology and data analytics tools to better manage patient care and costs. After joining these ACOs, practices gain a more comprehensive view of their patients’ total cost of care, gaps in quality of care, and experiences throughout the entire health care system, the companies said.

 

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Kaiser Health News Report: Clinics Treating Immigrants Find Themselves in Limbo Around Notification

January 15, 2019
by Mark Hagland, Editor-in-Chief
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The clinicians and leaders of U.S. patient care organizations continue to find themselves in a policy limbo around the information they share with federal and state authorities around their care for undocumented immigrants

The clinicians and leaders of U.S. patient care organizations continue to find themselves in a kind of policy limbo around the data and information they share with federal and state authorities around their medical care for undocumented immigrants, a new report in Kaiser Health News finds.

As Ana B. Ibarra wrote in a new report in Tuesday’s Kaiser Health News, “While the Trump administration decides whether to adopt a controversial policy that could jeopardize the legal status of immigrants who use public programs such as Medicaid, doctors and clinics are torn between informing patients about the potential risks and unnecessarily scaring them into dropping their coverage or avoiding care.” In her story, Ibarra quoted Tara McCollum Plese, chief external affairs officer at the Arizona Alliance for Community Health Centers, which represents 176 clinics, as saying, “We are walking a fine line. Until there is confirmation this indeed is going to be the policy, we don’t want to add to the angst and the concern.” However, if immigrants do come to a clinic wondering whether using Medicaid can affect their legal status, trained staff members will answer their questions, Plese told Ibarra.

Patient care organization leaders are working to figure out how to handle the situation, with some providers deciding to prepare their patients for the potential enactment of the proposal. At Asian Health Services, a clinic group that serves Alameda County, Calif., staff members pass out fact sheets about the proposed changes, provide updates via their patient newsletter and host workshops where patients can speak to legal experts in several Asian languages. “We can’t just sit back and watch,” CEO Sherry Hirota told Ibarra. “We allocate resources to this because that’s part of our job as a community health center — to be there not only when they’re covered, but to be there always,” even when that coverage is in jeopardy, she said.

The proposed “public charge” rule, which is awaiting final action by the U.S. Department of Homeland Security, would allow the federal government to consider immigrants’ use of an expanded list of public benefit programs including Medicaid, CalFresh and Section 8 housing as a reason to deny lawful permanent residency — also known as green card status. Medicaid is the state-federal health insurance program for low-income people. Currently, people are considered public charges if they rely on cash assistance (Temporary Assistance for Needy Families or Supplemental Security Income) or need federal help paying for long-term care.

 

 

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