Independent Health has started a new company to help a group of primary care physicians make the transition as health care reimbursement makes a dramatic change to what's known as value-based payments.
Value-based care ties payments to quality, efficiency and effectiveness, such as reducing hospital readmissions, tracking performance and improving preventative care. That's different from paying doctors and hospitals fees for services based on the amount of care they provide, a system critics say created incentives to over treat and over prescribe.
Evolve Practice Partners will serve the 33 doctor groups that participate in Independent Health's Primary Connection. The company will assist them with managing multi-payer risk contracts, achieving quality and cost of care metrics, tracking performance, analyzing patient data and helping control administrative expenses.
Independent Health in 2012 helped establish The Primary Connection, a group of more than 200 physicians that have worked closely with the insurer on coordination of care, reducing extreme variation in treatment for common medical problems, and other initiatives.
“Practices today are faced with many challenges that increase their administrative burden as health care moves to a more value-based payment structure," James Walleshauser, president of Evolve Practice Partners, said in a statement.
The slow and difficult shift to value-based payment is being driven in large part by the federal government as the Centers for Medicare and Medicaid Services seeks to tie 50 percent of Medicare payments to quality or value through alternative payment models by the end of 2018. The Affordable Care Act, also known as Obamacare, included funding to encourage experimentation in new payment arrangements that reward quality and efficiency.
The new payment systems rely heavily on physicians and health plans sharing information about medical claims, practice patterns and other metrics.
“Many physician practices – other than large, mega-practices or accountable care organizations – will be challenged to comply with the data collection, infrastructure and reporting requirements associated with the move to value-based care,” said Dr. Michael W. Cropp, president and CEO of Independent Health.
Evolve Practice Partners will operate as part of the Independent Health Corp., a for-profit, wholly owned subsidiary of Independent Health. Other companies under IHC include Nova Healthcare Administrators, a third-party administrator of self-funded benefits; Pharmacy Benefit Dimensions, a pharmacy benefit manager; and RelianceRx, a specialty pharmacy manager and distributor.