As the health care landscape
transitions to value-based care and Medicare Advantage enrollment reaches new
highs, new joint ventures have popped up as providers, traditional insurers and
other new entrants position themselves to launch MA products.
Lumeris, a subsidiary of Essence Group Holding Corp., aims to be one of the catalysts behind the transition from fee for service to value-based care. Its recent partnership with BayCare Health System enabled the not-for-profit health system to offer an MA plan in four Florida counties, pending CMS approval.
"What Lumeris brings to us is the ability to empower primary care physicians through easier access to information so that they can do as much as possible in the office as opposed to referring to 10 different specialists," says Jim Beermann, president of BayCare Select Health Plans.
Lumeris works to ensure that incentives are aligned between the payer and the provider organization and that total cost of care incentives are balanced with quality and access. It also uses multiple sources of data to identify physician engagement opportunities and develops a "role-based playbook" to drive results in a value-based environment.
Pendulum HealthCare Development Corp. (PHDC) has seen more activity than ever in the past five years among providers starting their own plans instead of partnering with an insurer. PHDC principal Bill DeMarco says that successful provider-sponsored health plans are looking to partner with other provider organizations that want to form their own health plan but lack the resources and knowledge.
PHDC recommends that provider groups that aren't ready to fully manage their own health plan, especially those in rural and secondary markets, partner with third-party administrators and outsource claims for direct employer contracting.
DeMarco adds that there are more accountable care organizations (ACO) looking to set up their own MA plans as well.
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