The Role of Provider-Sponsored Health Plans in Value-Based Care

November 3, 2021  by  Allzone MS   189

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Provider-sponsored health plans can be naturally aligned with value-based care goals while also being attuned to providers’ needs.

Providence Health Assurance’s Medicare Advantage provider-sponsored health plan received a five-star rating through the CMS Medicare Advantage Star Ratings system for the 2022 Medicare open enrollment season. The health plan, which serves Oregon and Washington State, is the only health plan in Oregon with employed and community-based providers.

Robert Gluckman, MD, chief medical officer of Providence Health Plan, has been working for Providence Health Assurance in a variety of capacities for over a decade and told Healthcare Strategies that he has found the health plan’s provider-sponsored model to be well-aligned with value-based care strategies and providers’ needs.

“As a provider-sponsored plan, one of the key differentiators is that we are able to have a perspective that is aligned with the physicians who actually care for people on the front lines,” said Gluckman. “It is just part of our DNA and how we think about how we care for people and how we think about how we partner with providers because that is a good chunk of who we are.”

Because the payer behind a provider-sponsored health plan model is a health system–unlike in a payvider model–the health plan may be able to communicate more clearly with its provider network. The partners may not face the same trust issues that health plans encounter when operating in other structures. Trust and communication are essential to a strong value-based care approach.

To Gluckman, the dynamic between health system and health plan in a provider-sponsored health plan is particularly influential in the Medicare Advantage space, where care management is so crucial to patient outcomes.

“The needs that older people have are going to be different because they may have more challenges around maintaining activities of daily living, or they may be burdened by a different number of disease states,” Gluckman noted.

While providers are easily aligned on the drive toward better quality care, helping doctors align around value-based care cost dynamics can be challenging.

However, as the pressures of pharmaceutical expenses weigh down patients financially, Gluckman has seen providers’ resistance to value-based reimbursement shift. The provider-sponsored health plan partnered with pharmacies and independent physician associations to incentivize providers to focus on preventive care and chronic disease management strategies.

“A combination of defined metrics and financial incentives that reward people or give them the resources they need to implement that model has been really highly successful for us,” Gluckman said.

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