Case study: MDs succeed with Medicare HMO business

A group of St. Louis physicians have built a thriving Medicare Advantage plan they say is more financially friendly to providers than plans run by managed care companies. According to Charles Wiley, M.D., chief medical officer with Essence Healthcare, the plan manages to offer doctors better pay than other plans while keeping benefits rich for members. It also works to keep their payment schedule flexible, offering physicians a combination of capitation, fee-for-service and incentive payments to keep patients healthy.

The health plan, which began operations in 2004 in St. Louis, now operates in Kentucky and Washington state as well. Essence is funding its growth partly with an investment from a venture capitalist and partly by offering equity stakes to physicians in Kentucky and Washington.

To learn more about Essence:
- read this Modern Physician article (reg. req.)

Suggested Articles

Humana has added additional providers to its orthopedic bundled payment models, the company announced. 

States that spend more on primary care have better outcomes, including fewer hospitalizations and emergency department visits, says a new study.

Technology company Philips has acquired Boston-based startup Medumo, the developer of patient navigation and engagement solutions.