Payviders: the new integrated delivery system
Cathy Eddy, President, Health Plan Alliance
07/14/2015
While we were in Salt Lake City for the System/Health Plan Value Visit, we met with the research firm KLAS. They are conducting a survey with “Payviders,” or health systems that have their own health plan. This is a new term for a concept that has been around for more than 30 years, but seems to be gaining traction again as more providers move into value-based reimbursement (don’t call it capitation – that is so 90s), and more are leveraging their existing health plan, partnering with one, or even starting a health plan.I’ve been working in the space between payers and providers since 1982 and running the Health Plan Alliance for nearly 20 years. What seems different now is the level of strategic alignment between the plans and their provider sponsors. The expertise that exists in a health plan is a great (essential? necessary? logical?) resource for a health system that is moving into Population Health, establishing ACOs and negotiating contracts for value-based payments and incentives. Many of the competencies it takes to run a health plan are critical elements for health systems that are taking on risk.
During our System/Health Plan Value Visit, we had three great case studies by health system leaders.
· Joe Mott, VP, Population Health at Intermountain Health Care discussed how their mission is driving their strategy to transform healthcare and keep the medical cost trend low. He explained how shared accountability is the strategy the system owns, while community health includes the strategies on which we collaborate. SelectHealth, which is a part of the Intermountain system, served as our host for this meeting.
· Joe Gifford, Chief Executive of Providence Accountable Care Organization in Seattle, shared their journey as one of two systems selected to contract-direct with Boeing. This agreement requires a major build-out of infrastructure and a complex web of partnerships, which he said leveraged a lot of the expertise in the Providence Health Plan. During the development phase, the ACO reported to the CEO of the health plan. Providence recently hired an EVP of Population Health, who will have oversight of the ACOs and health plan. Joe shared that when a provider directly serves the customer with a risk structure, it unleashes the forces of innovation.
· Todd Sandman, SVP and Chief Strategy Officer, Presbyterian Healthcare Services, told us about their relationship with Intel, which moved its strategy to “going local and connecting care.” Intel selected Albuquerque as the first of several markets to implement this strategy with Presbyterian. Intel’s goal is to be the “healthiest workforce on the planet.” Presbyterian and its medical group are now engaging differently with employers, developing initiatives that are employer-specific and adding innovative care models, such as video visits.
These three case studies will be available soon as podcasts. If you are interested in hearing the presentations and get copies of the presentation material on our website, click here.
The Health Plan Alliance will offer an expanded membership with custom programming in 2016 for health systems that are affiliated with our member health plans. We’ll be rolling out the details on this program later this year.
As the lines blur between payers and providers, as systems become more integrated in their strategy, employers build closer relationships with delivery systems and as consumers engage more in their health care decisions, perhaps “Payviders “will become the norm.
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