How a payer-provider joint venture is lowering costs

ElevateHealth, a nonprofit partnership established last year by Harvard Pilgrim Health Care and two leading health systems in New Hampshire, is proving that payers and providers can collaborate and integrate care to save costs, reported New Hampshire Business Review.

To cut costs, New Hampshire's Dartmouth-Hitchcock and Elliot Health System agreed to take lower reimbursement rates from Harvard Pilgrim, and all three organizations will share in any profits achieved, FierceHealthPayer previously reported.

The joint venture already has lowered costs by as much as 20 percent, ElevateHealth President Corbin Petro said in an interview with NHBR.

"It's sort of the first in the country to have a model like this," she said. "By sharing data, by integrating and having each entity doing what they are best at, instead of often duplicating efforts, there is an opportunity to reduce costs and improve care."

Key to ElevateHealth's success, Petro said, is "having the providers be joint owners." That helps address the healthcare industry's struggle with "misaligned incentives" where providers are paid to perform more services instead of quality outcomes.

Although ElevateHealth's provider network is limited to about 400 primary care doctors and 2,600 specialists between the two providers' facilities, Petro said it's not cherry-picking the lowest-cost providers in the state like other insurers are doing across the country. ElevateHealth's providers include high-cost facilities, she said, adding that "we are really focusing on quality."

ElevateHealth is selling its individual plans for the first time on New Hampshire's health insurance exchange during this enrollment period. Petro expects to see growth in the small, medium and large groups.

To learn more:
- read the New Hampshire Business Review article

 

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