WellPoint, Cigna and large hospital chains expected to actively engage in medical home partnerships
Source: Pharmawire – January 14, 2011
By: Jennifer C. Smith-Parker (Washington, DC)
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Large insurance companies such as WellPoint (NYSE: WLP) and Cigna (NYSE: CI), as well as large hospital chains, are expected to actively partner with each other and with nursing homes and physician groups in order to create “medical homes” in 2011 and beyond, healthcare experts told Pharmawire.
The “homes” would not be brick-and-mortar establishments but rather describes a system of ensuring quality patient care among the healthcare players. Federal guidelines on medical homes are expected in 1Q11, a healthcare attorney said.
The Patient Protection and Affordable Care Act (PPACA), passed in March, established community health teams to support the concept of patient-centered medical homes. Essentially, the HHS Secretary would provide grants to, or enter into contracts with, “eligible entities” to establish community-based, interdisciplinary teams to support primary care practices, including obstetrics and gynecology practices, within the hospital service areas served by the entity.
While physicians will be the drivers of medical homes, hospitals and insurance companies will also take an active interest, sources said. Although the concept of the medical home notion was introduced in the 1960s, PPACA’s detailed requirements of medical home components suggest that future US healthcare will be centered on access to comprehensive, community-based, coordinated care, sources concurred.
This focus on medical homes has generated a new arena in which payers, providers and vendors can align and coordinate care, said a healthcare policy consultant and former CMS official.
Insurers such as BlueCross BlueShield, UnitedHealth (NYSE: UNH), Wellpoint and Cigna are “definitely” pushing medical homes because they allow for risk sharing, said Tip Ghosh, managing director, Strategic Health Resources.
The definition of medical homes is still considered nebulous but the funding opportunities are expected to encourage large hospitals and insurance companies to invest in the concept, said Ron Wince, CEO of Guidon Performance Solutions. He said he expects these sectors to reevaluate their business models so as to include medical homes.
In addition to insurers like Kaiser Permanente and UnitedHealth, regional insurers such as Independent Health will likely be interested in expanding medical homes, the consultant said. He added that they are more likely than smaller players to have elaborate physician and non-provider networks.
It is highly likely that national hospital chains will be involved in medical homes as much as local hospitals, said Michael Cook, of counsel, Liles Parker. He said he expects that medical homes will be considered the “patient care manager” that accepts CMS payments and then disburses them to its hospital and service contracts.
The medical homes notion is very similar to the accountable care organizations (ACOs) concept that hospitals and insurers have also taken an active interest in, said a second healthcare attorney. Insurers, hospitals and physician practices are needed to integrate the model into patient care, he added.
Medical homes have saved millions of dollars of health care expenditures by preventing visits to ER departments and by reducing/eliminating hospital stays, said John Wyand, an associate at Squire, Sanders & Dempsey. Despite the negative impacts on profits, hospitals are and will be interested in medical home development because they can provide the required primary care nucleus of an ACO, he said.
An ACO is required to have adequate primary care capacity to care for 5,000 Medicare beneficiaries. Medical homes, as well-organized providers of primary care, will be an important central element of an ACO, Wyand added.
All contents © 2011 Pharmawire. All Rights Reserved.
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