Payment Innovation: Coming To A Practice Near You

Several payers are making payment innovation more progressive based on some interviews I did this week:

  • Anthem’s payment innovation group is making a case that its pay-for-value program doesn’t leave you at the alter if you’re a physician practice trying to integrate behavioral health into services. The MCO is offering a PMPM, shared savings plus, and here’s the kicker, a support based model to help practices figure out the best way to integrate, such as whether to embed practitioners in the office. Webcasts and other services are offered in the program.
  • An MCO in the Northeast is sending a survey of sorts to select behavioral health and primary care providers to help build an ACO network, asking for experience, EMR status, willingness and experience taking risk and other factors. We believe, as our poll this week suggests, that this is an emerging trend and a good one for healthcare. In the end, the practice–with guidance/recommendations from the MCO–would be placed in the most appropriate risk model, if one exists, everything from upside risk with bonus to just upside risk to a 50-50 risk split to 100% up and downside risk.
  • A Medicaid MCO in Pennsylvania has offered a $400 PMPM to Care Connections, an outpatient service in the Lancaster Health System that closely works with Medicaid patients. The cost to the plan, $2400 over 6 months, is far less than a single admission.
  • An integrated family clinic-behavioral health center in Wisconsin is noodling with the idea of a flat fee payment concierge model that will include going into schools to advocate for a child’s need for testing or ‘helping set up a child or adult in a community program’. They are also pitching the idea, as part of shared savings plan with two local health plans. The clinic, which is still developing the concept, said ‘taking insurance out of the equation’ may reduce family stress and cost, and will allow them to pay for services as needed, but they are also hopeful to work with insurers to find a solution. The clinic will have its own network, which will include ‘volunteers’ and a range of arts, educational and athletic programs.

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