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Our Take: The Darwin Value Index

Sep 28, 2020

Editor’s note: It’s rare that we would take the lead story and turn it into something about us, but we had a relatively slow health care news week. We have a new tool on our website that we’ve been wanting to share with our readers. This week seemed like a good time to do so.

In 2016, we created the Darwin Value Index (DVI) as a means to 1) measure an integrated health system’s progress from volume to value, and 2) have a standardized method to compare health systems and their level of sophistication

Just recently, we put an interactive map on our website of the DVI scores for many of the health systems we are tracking. Feel free to play around with the tool.

A caveat: We’re still working out the kinks of visualizing the data properly (e.g., we are well aware that Banner Health isn’t headquartered near the Grand Canyon).

The DVI scores a health system on six dimensions:

• Quality of vertical integration
• Level of technology integration
• Payer experience
• Experience with alternative payment models
• Percent of revenue tied to alternative payment models

• Percentage of employed physicians (versus affiliated)

Each dimension is measured on a 10-point scale, with the DVI calculated as the mean of all six scores. We have considered different weighting schemes for the DVI; for now, it’s a simple average.

We categorize the health systems according to the following scale:

0-3.4 Idle
3.5-4.4  Novice
4.5-5.4  Competent
5.5-6.4  Proficient
6.5-7.4  Distinguished

7.5 or higher  Expert

As one might imagine, payer-provider systems such as Kaiser Permanente, Geisinger, and Intermountain tend to score the highest, as they have tightly integrated networks across the continuum of care, employ most, if not all, of their physicians, and are experienced with risk-based contracts.

While the index is admittedly subjective, we determine these scores based on multiple interviews with system executives over time and in relation to other integrated health systems. It’s subjective, not arbitrary. And we are constantly reevaluating the DVIs across the systems we track.

The biggest limitation of the DVI is when applied to large, multistate health systems with multiple subnetworks. It is difficult to score CommonSpirit, for example, with a single DVI. In those cases, it makes more sense to score each subnetwork separately.

For example, Greensboro, N.C.-based Cone Health (DVI=5.2), an integrated delivery network within Atrium Health (DVI=5.0), is the most advanced network within the larger system. Other networks within Atrium Health are less advanced, based on our scoring criteria.

Of the roughly 250 health systems we are tracking, most fall within the Competent or Proficient categories. If you were to plot them on a graph, it would look like a typical bell curve.

That curve has shifted over time as health systems have become more integrated, more adept at using technology, and more familiar with alternative payment models like bundles and ACOs. If we were to look back to 2016, you would find many systems characterized as Idle or Novice, with the shape of the curve looking more like an F-Distribution.

To learn more about the DVI and its applications, or to provide feedback on the model, please contact John Marchica at jm@darwinresearch.com.

What else you need to know

Johnson & Johnson (J&J) has begun an international Phase III trial of a single-dose COVID-19 vaccine under development by Janssen Pharmaceuticals, the company announced last Wednesday. The placebo-controlled trial, dubbed ENSEMBLE, will test the safety and efficacy of the vaccine in as many as 60,000 adults, including “significant representation from those … over age 60,” and “those with and without comorbidities associated with an increased risk for progression to severe COVID-19,” J&J said. Dr. Paul Stoffels, chief scientific officer at J&J, said the company expects trial results by year-end or early next year, Reuters reported. Not only does this vaccine require just one dose (compared with rival vaccines under development that require two doses), but it also does not need to be stored at extremely cold temperatures like most other vaccine candidates do.

Two new value-based payment models will take effect on Jan. 1, CMS recently announced. Certain providers designated by CMS will be required to participate in the models. The End-Stage Renal Disease Treatment Choices Model is designed to encourage increased use of home dialysis and kidney transplants for patients with chronic kidney disease. It will affect approximately 30% of kidney care providers nationwide, CMS said in a press release, and will save Medicare an estimated $23 million over five and a half years. The Radiation Oncology Model creates a bundled-payment system for 30% of all radiation oncology episodes and includes 16 types of cancer. That model is expected to save Medicare about $230 million over five years, the agency said in a separate news release. In a press statement, the American Society for Radiation Oncology urged CMS to delay the model’s start date, because many providers continue to grapple with pandemic-related challenges, and to launch the model with voluntary rather than mandatory participation.

Google-backed telehealth company Amwell saw its stock jump 42% the day after completing an initial public offering in which the firm raised $742 million. In documents filed with the Securities and Exchange Commission earlier this month, Amwell said it intended to sell 35 million shares of Class A common stock at $14 to $16 per share, but the company subsequently announced that it had sold 41.2 million shares at a price of $18 per share. On the first day of trading, the stock opened at $25.51 per share.

In separate news, attorneys for competitor Teladoc sent a letter to Amwell’s co-CEOs demanding that Amwell stop selling, making, using, and importing certain products, They alleged that the products infringe on patents Teladoc gained when the company acquired startup InTouch Technologies in January. Of note, Amwell sued Teladoc in 2015, accusing Teladoc of having an online platform too similar to Amwell’s technology. A judge later dismissed the lawsuit and invalidated the disputed patent.

The FDA authorized the first point-of-care COVID-19 antibody test last Wednesday. The Assure COVID-19 IgG/IgM Rapid Test Device, manufactured by Hangzhou, China-based Assure Tech. Co., Ltd., was first authorized for emergency use in July; at the time, it was authorized for use by labs to identify individuals with antibodies to SARS-CoV-2. The FDA reissued the emergency use authorization last week for point-of-care use. As a result, finger-stick blood samples can now be tested in settings such as physicians’ offices, hospitals, and urgent care centers. The test is available by prescription only.

Dr. William Harwin, founder and former president of Florida Cancer Specialists & Research Institute (FCS), was indicted for allegedly conspiring with a competitor — identified by the Department of Justice (DOJ) only as “Company A” — to monopolize and allocate cancer treatment in southwestern Florida. In a press release, the DOJ said Dr. Harwin and co-conspirators allegedly had an illegal agreement, starting as early as 1999 and continuing at least until 2016, under which medical cancer treatments such as chemotherapy were allocated to FCS and radiation cancer treatments were allocated to the unnamed competitor. Dr. Harwin stepped down from his role as president of FCS in 2018. In April, FCS agreed to pay $100 million in federal penalties and $20 million to the state of Florida to resolve charges related to the same allegations.

UMass Memorial Health Care and Harrington HealthCare System agreed on definitive terms for UMass Memorial to acquire Harrington Memorial Hospital, MassLive reported on Wednesday. When UMass Memorial announced the intended affiliation in January, the anticipated timeline for final approval was six to nine months. The pandemic led to delays in the due diligence process, but now that the organizations have agreed to move forward, they will seek regulatory approval from the state of Massachusetts. The agreement calls for UMass to run Harrington’s Southbridge and Webster campuses for a minimum of five years; financial terms were not disclosed.

Dr. Conor Delaney will become CEO and president of Cleveland Clinic’s Florida region, effective Oct. 15, the health system announced Tuesday. Dr. Delaney is currently chairman of Cleveland Clinic’s Digestive Disease and Surgery Institute; he joined Cleveland Clinic as a fellow in 1999 and began his career with the health system the following year on the clinical associate staff.


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