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In the space of less than a
month, a health care technology company called Aledade has announced new
alliances with two health insurers and expanded an existing partnership with
another. Those insurers — CareFirst BlueCross BlueShield, Humana Inc. and Cigna
Healthcare — say their goal in working with the company is two-fold: (1) to
help physician practices remain independent rather than opting for corporate
ownership, and (2) to hasten the move from fee-for-service to value-based
payment models.
CareFirst hopes to support
independent clinicians
- For CareFirst, the benefits
of helping independent practices stay that way are clear.
- “Our
independent practitioners, their financial model is very different than
the employed practitioners, and the independence gives them the
opportunity to exercise their own judgment on a regular basis about the
needs of their population,” explains Brian Wheeler, vice president of
provider collaboration and network transformation at CareFirst. For
example, he says, independent physicians can refer patients to “the very
best orthopedic surgeon” regardless of who employs that doctor, rather
than feeling constrained to refer only to doctors within a certain
health system.
- “In any sector
of the economy, when markets become too consolidated, you don’t have
healthy competition in the markets,” Wheeler adds.
Corporate purchasing of
practices accelerates
- Yet independent
physicians are becoming an increasingly rare breed. An Avalere
Health study that examined physician practice trends between 2019 and
2021 found that 74% were employed by hospitals, health systems or
corporate entities as of Jan. 1, 2022.
- Large companies
that own health insurers, such as UnitedHealth Group and CVS Health
Corp., have made no secret of their plans to snap up physician
practices. Humana is also trying to stock up on senior-focused primary
care practices, although it is doing so by buying
clinics that the Medicare Advantage insurer built from the
ground up with the help of a private equity partner.
- Meanwhile,
Humana and Aledade have been working together since 2019 in a limited
number of markets, according to a March 2 press
release. Through that partnership, the firms said they were able
to increase primary care visits, reduce inpatient hospitalizations by 5%
and cut readmissions by 12%. Now, Humana and Aledade plan to phase in a
10-year term for “current and new state-wide agreements, which include a
pathway to full risk.”
Cigna inks Aledade deal
for MA members
- The most recent
Aledade-insurer announcement comes from Cigna, as the firms said on March 23
that under a new partnership, Cigna’s MA customers “can now receive
value-based care from Aledade’s network of independent primary care
practices” in Delaware, Maryland and the District of Columbia.
- “We want to
improve the health and vitality of our customers, and one way we can do
this is by working with providers that focus on improved health outcomes
while keeping care affordable,” said J.B. Sobel, M.D., Cigna Healthcare
Medicare’s chief medical officer. “With Aledade, we are able to increase
access to this care, and further advance this mission for Cigna
Healthcare’s Medicare Advantage customers.”
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