Blues Plans Invest in Chronic Care to Gain MA Ground

From Health Plan Weekly

Blues plans increasingly are investing in or partnering with companies that can provide in-home care management to chronically ill, medically fragile members in a push that one consultant says could help them with the Medicare Advantage market.

Three Blues plans — Anthem, Inc., Blue Shield of California and Florida Blue — have inked deals in the last two months, indicating a growing focus on complex chronic care outside the hospital, especially in the Medicare Advantage space, says William De Marco, founder and president of Pendulum HealthCare Development Corp.

Anthem on May 23 said it agreed to acquire Aspire Health, which serves consumers in 25 states under more than 20 contracts with health plans. The company uses proprietary predictive clinical and claims-based patient algorithms to identify patients with a serious illness who may benefit from an extra layer of support. Once patients are identified, Aspire assigns a care management team that includes physicians, nurse practitioners and social workers.

Meanwhile, Blue Shield of California is teaming up with Landmark, which provides home-based medical and behavioral care plus social support services to patients 24/7. Landmark conducts routine visits, urgent care visits and post-discharge home visits for patients to ensure a safe transition from the hospital or skilled nursing facility back home.

In April, Florida Blue announced its partnership with corporate sibling PopHealthCare to deliver a suite of in-home patient care services to clinically fragile members who have had recent hospital stays or who have complex chronic medical conditions.

De Marco notes that Blue plans in California, Texas, Minnesota and Massachusetts have had programs like this in place, while most recently, health plans have sought to tie in pharmacists, so that they can help to identify members who aren’t compliant with their prescription use.

"We can put this under the category of 'social determinants of care,' where insurers are now recognizing that taking social responsibility for their population has a big payoff in terms of savings from avoidable disease as well as rapid recovery from any injury," he says.

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