MRLC Members: Below is an interesting article from our friends at Open Minds about the blurring of lines between providing organizations and insuring organizations. The move towards integration with primary care has opened new possibilities for behavioral health that did not previously exist in New York State. Much more on integration and new and innovative models of care will be presented at this year’s Executive Seminar on April 24th and 25th . This year’s Seminar will highlight presentations that prepare for two big policy movements capturing everyone’s attention for the coming year: the BH transition in managed care and the DSRIP implementation through the 1115 waiver.
The final terms and conditions of the DSRIP agreement between NYS DOH and CMS will be resolved in the coming weeks. Our panels of agency representatives and stakeholder experts will analyze the upcoming final rules and discuss their relevance for the BH community and other policy transitions. This discussion will take place in the last few weeks before project proposals will likely be due to the state for inclusion in the DSRIP funding plan. As you learn more about DSRIP and how it relates to your business, your health care, or the managed care transition, be sure to get the most up-to-date information at the Executive Seminar before finalizing project plans and partnerships. The Seminar will also offer opportunities to build relationships with potential partners to further growth and expertise in the new models or managed care and DSRIP. Register before April 4th for early bird rates. Register and see the entire exciting and timely program here: : https://rms.nyaprs.org/2014-executive-seminar/
Developed by OPEN MINDS, 163 York Street, Gettysburg PA 17325, www.openminds.com. All rights reserved. You may not alter, transform, or build upon this work. You may not use this work for commercial purposes without written permission from OPEN MINDS.
The Blur Continues
A few months ago, we reported on the increase in the purchase of service provider organization by insurers (see Emerging Insurer-Provider Integrationall members). That blurring of the line between “insuring organization” and “provider organization” continues – with some interesting twists.
First, the formation of new accountable care-like organizations has continued – more provider-sponsored initiatives (often in partnership with insurance organizations) to manage consumer care with some element of financial risk or reward. We’ve covered a few of these recently.
- New Jersey’s Aetna And Atlantic Accountable Care Organization Sign ACO Agreementall members
- University Hospitals, UnitedHealthcare Collaborate On Accountable Care Organization (ACO)all members
- Humana Forms ACOall members
- Oregon Managed Behavioral Health Organization To Launch Coordinated Care Organizationpremium members
- Illinois Selects Six Health Care Networks To Launch Care Coordination Project For Adults With Disabilitiespremium members
And, traditional federally qualified health centers (FQHCs) are getting into the health insurance business. There are a couple recent examples. First, in California. The Redwood Community Health Coalition (RCHC), a partnership of FQHCs in northern California, launched a new Medicare ACO (see California Federally Qualified Health Centers Form Medicare ACOpremium members). RCHC is a consortium of 17 health centers with 41 sites serving 240,000 patients (including 7,800 Medicare beneficiaries) in Napa, Sonoma, Marin, and Yolo counties.
And second, a similar group in Florida. In 2008, the Jessie Trice Community Health Center in Miami invested $120,000 to start Prestige Health Choice, a for-profit Medicaid health plan. They recently made good on that investment when Florida Blue bought a minority stake in the health plan, according to Nonprofit Health Centers Go Into For-Profit Insurance Business in Kaiser Health News.
And insurers are going into the “consulting” business – providing expertise to entrepreneurial provider organizations. For example, WellPoint Inc. has begun advising health care providers on care management through its CareMore unit. The company recently announced a contract with Emory Healthcare, for the purposes of jointly managing Medicare patients (see WellPoint Advises Health-Care Providers). This initial deal will be for approximately 7,500 Medicare beneficiaries and will focus on improving patient monitoring, preventive care, and cutting down on emergency rooms visits.
And finally, we have insurers changing their relationship with provider organizations – with more gainsharing and performance-based contracts. We’ve reported on this subject before – What Do Payers Want? They Want You To Define Your Value!all members, Getting Your Team Ready for Performance-Based Contractingall members, and Getting Your Team Ready For Performance Managementall members. And, next week we’ll give you an update on how some of the major players are moving ahead with these innovative relationships in the behavioral health space. Stay tuned and look carefully – the “blur” is continuing.