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Our Take: University of Tennessee, Vanderbilt form health network

Oct 01, 2018

University Health Network (UHN) and Vanderbilt Health Affiliated Network (VHAN) announced a partnership for value-based health care that reaches throughout the state of Tennessee.

Our TakeLet’s break down the details of this massive alliance.

UHN is a clinically integrated network and Medicare accountable care organization that includes The University of Tennessee Medical Center (UTMC), University Physicians’ Association and other partnering entities throughout eastern Tennessee. UHN represents 87 practices and more than 1,000 physicians, according to the press release issued Wednesday.

VHAN is a network of health systems, physicians and employers formed by Vanderbilt University Medical Center. The clinically integrated network includes a dozen health systems, 5,000 physicians and more than 60 hospitals. Health systems that are part of VHAN blanket the state, from West Tennessee Healthcare to the Mountain States Health Alliance in the Tri-Cities.

One important benefit for UHN—and in part what makes this deal consequential—is in-network coverage for people who are insured by VHAN-approved insurance plans.

More important, the network is a value-based model: physicians and hospitals will be paid for outcomes and incentivized to reduce costs. By joining forces, providers expect increased collaboration through data sharing, and better management of chronic diseases.

According to onreport, through chronic disease management programs VHAN has been able to improve outcomes, reduce emergency department usage and reduce readmissions for patients with congestive heart failure, COPD and diabetes—all of which have higher than the national average rate for Tennesseans.

This is an ambitious effort between the two academic medical centers to tackle serious population health issues throughout the state of Tennessee.

However, despite the alliance being hailed as such, we weren’t provided any details on exactly how it is value-based. Are there shared savings, and if so, how will that work? Is there a global budget, and if so, who sets it? How are physicians and hospitals incentivized based on outcomes, and who decides what outcomes matter?

We have reached out to officials from UHN and VHAN and will report more here as we learn the specifics.

What else you need to know
Aetna has agreed to sell off its Medicare Part D prescription drug business to WellCare Health Plans, Inc., which includes about 2.2 million members. Aetna said the purchase price is “not material” and does not affect its individual or group Medicare Advantage, Medicare Advantage Part D or Medicare Supplement plans. The deal is subject to customary closing conditions and is a significant step in obtaining the Justice Department’s approval of Aetna’s merger with CVS. More here.

Separately, Maria Vullo, New York’s top financial watchdog, warned about the pending CVS-Aetna merger in a letter to the Connecticut state insurance commissioner. Vullo argued that the deal would result in an unfair competitive advantage for the combined company in insurance and pharmacy benefit manager (PBM) markets, and that consumers would be harmed by higher premiums and drug prices. The letter was sent in advance of the public hearings being held in Connecticut this coming week. Read the letter here.  

Community Health Systems (CHS) agreed to a $262 million settlement with the U.S. Department of Justice regarding certain activities conducted by Health Management Associates (HMA) prior to CHS’ acquisition of HMA in 2014. CHS said it was aware of the HMA investigations before closing the transaction and, following the acquisition of HMA, CHS worked cooperatively with the government in its investigation. The DOJ whistleblower suit alleged that HMA billed Medicare, Medicaid and TRICARE for inpatient admissions for emergency room visits that should have been billed as outpatient or observation cases between January 2008 and December 2012. The settlement also resolved allegations of Stark and Anti-kickback Act violations.

Anthem is returning to the Ohio ACA exchange in 2019 and will sell individual health plans in 25 counties. In a statement, Anthem said it assesses the market each year and “participates where the company believes there is sufficient stability.” Open enrollment for next year’s coverage begins Nov. 1 and runs through Dec. 15. Anthem left a number of state exchanges last year, including those in Ohio, California, Maine, Nevada and Virginia. The Ohio move could signal the insurer’s return to ACA exchanges in other states as well. More here.

Blue Cross Blue Shield of Michigan (BCBSM) is incentivizing consumers to shop for lower-priced providers through a new program called Blue Cross Rewards. More than 520,000 members among the insurer’s commercial PPO group members can receive up to $550 per member per year in e-gift cards by choosing a reward-eligible location among providers listed on the BCBSM member website. The program is for non-emergency imaging and outpatient services, including mammograms, ultrasounds, colonoscopies and sinus surgeries. More here.

CMS has awarded seven organizations cooperative agreements to help the agency develop, improve or expand quality measures for Medicare’s Quality Payment Program (QPP). The organizations include Brigham and Women’s Hospital for orthopedic surgery; the American Society for Clinical Pathology for pathology; the Regents of the University of California, San Francisco for radiology; the American Psychiatric Association and the University of Southern California for mental health and substance use; the Pacific Business Group on Health for oncology; and the American Association of Palliative Medicine for palliative care. Press release here and award details here.

What we’re reading
Mental Health Services for Medical Students—Time to Act. NEJM  9.27.18 (subscription required)
Fish Oil Derivative Cuts CV Events for Some by 25%. Medscape 9.26.18 (login required)
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