Teaching hospitals can prepare for value-based care with integrated network alliances

Healthcare's transition from fee-for-service to value-based care models is hitting teaching hospitals especially hard. However, if such hospitals strengthen their ties to integrated delivery networks that emphasize primary care and multispecialty group practice, they can significantly improve their chances of a successful transition, argues a post from the NEJM Catalyst blog.

For example, nearly two years ago Emory Healthcare, as part of its shift toward population-based payment models, partnered with CareMore Health System, which operates Medicare Advantage plans in several states, write Michael M.E. Johns, M.D., and Jonathan S. Lewin, M.D., of Emory and Sachin H. Jain, M.D., of CareMore.

The partnership turned responsibility for numerous Atlanta-area Medicare Advantage beneficiaries over to Emory, while CareMore worked with the system to overhaul clinical services and care coordination. This involved training and integrating CareMore's "extensivist physicians," who maintain continuity of care for patients with complex needs and conditions.

Medicare Advantage payment models offered Emory numerous advantages, according to the post, including:

  • Flexibility: Medicare Advantage's population-based payment structure gives participants larger financial resources as well as more room to invest in clinical capabilities and strategies, such as the extensivist model, according to the post.
  • Emphasis on the most vulnerable patients: The partnership was specifically devised to meet the needs of older adults with or at high risk for chronic conditions. Medicare Advantage offers plans that can be tailored specifically to individual patient needs, making it a good fit for these  patients. 

The approach used by Emory and CareMore will likely be adopted by more organizations in the near future, particularly Pioneer and Next Generation Accountable Care Organizations (ACOs), according to the post. "As this transition occurs," the authors write, "risk-adjustment and reimbursement structures will more closely resemble Medicare Advantage's structures than those of contemporary ACOs."

To learn more:
- here's the post

Suggested Articles

The profit margins and management of Community Health Group raise questions about oversight of managed care insurers.

Financial experts are warning practices about the pitfalls of promoting medical credit cards to their patients.

A proposed rule issued by HHS on Tuesday would expand short-term coverage, a move Seema Verma said will have "virtually no impact" on ACA premiums.