CareFirst BlueCross BlueShield is joining forces with Ryse Health, a company that specializes in providing in-person and virtual care for patients with uncontrolled Type 2 diabetes, in hopes of driving better long-term outcomes.
CareFirst officials said they believe the effort will help improve care by better pinpointing what they need most.
“This partnership with Ryse is unique from our perspective because it’s one of the first ways in which we’ve been able to create a longitudinal value-based program that is complementing the broader value-based program efforts that the organization has,” Nathan Coffey, CareFirst’s manager of payment transformation, told Fierce Healthcare.
“But there’s been a gap, not just with us, but across the industry where you have a lot of discrete care programs for specialists, but having that longitudinal tie that amplifies the impact of those larger population health programs—that’s harder to create," Coffey said.
For example, health plan and provider contracts in the U.S. often use 90 days as the length for an episode of care, whether for knee replacement or bypass surgery. CareFirst's program, which started in January, allows individuals with diabetes to have more than 20 interactions with Ryse team members in their first three months with either in-person or virtual visits.
In addition, getting that first appointment won’t be as troublesome, said Coffey. Individuals in the Washington, D.C., area must often wait about four months for an initial visit to an endocrinologist, and the gap between follow-up visits can last between three and four months.
In the new program, an appointment with an endocrinologist can be gotten within two weeks. The endocrinologist must have completed a fellowship in endocrinology, diabetes and metabolism.
In addition, the Ryse team includes a licensed dietitian and diabetes educator, a licensed social worker and a health coach.
The National Institutes of Health said that “persistent hyperglycemia in uncontrolled diabetes mellitus can cause several complications, both acute and chronic. Diabetes mellitus is one of the leading causes of cardiovascular disease, blindness, kidney failure, and amputation of lower limbs. Acute complications include hypoglycemia, diabetic ketoacidosis, hyperglycemic hyperosmolar state, and hyperglycaemic diabetic coma.”
Coffey said the team is "bullish on seeing good results as time goes on" in the multiyear partnership.
“We’re optimistic about the results that we’re going to see,” he said. “Ryse is a purpose-driven provider group focused on improving outcomes and willing to stake its claim to that space."
The program is launching as GLP-1 medications, like Ozempic and Wegovy, are making headlines as demand soars. Payers, including Medicare, have been hesitant to cover such medications as a weight-loss drug because of cost, but Coffey said Ryse's clinicians will have final say on what's best for the patient.
“The clinicians retain total decision-making around the best way to care for a member,” Coffey said. “This program doesn’t do anything to influence clinical decision-making.”
Of course, a value-based program wouldn’t necessarily turn to an expensive medication as the first tool it uses. As Coffey said: “This is just making sure that there’s the opportunity to recognize and reward Ryse to the extent that we’re seeing improvements in the population health overall.”
He added that CareFirst will closely monitor diabetes outcomes in order to give Ryse data it may need to adjust its program.
“We’ll study the results,” he said. “And if there’s a way to improve this arrangement or build a comparable arrangement that works similarly, then we’ll do that at a future date.”