Claims data helps Maryland CO-OP Evergreen Health boost primary care

By Leslie Small

Maryland's consumer operated and oriented plan, Evergreen Health, is already in select company--it's among fewer than half of the original 23 CO-OPs that are still standing. But a more important distinction, CEO Peter Beilenson, M.D., (right) tells FierceHealthPayer, is that it's the only CO-OP with affiliated primary care centers.

"That's where we have an advantage," he says. "We have this affiliated insurance company, the CO-OP, which has the claims data that can inform the primary care offices about what people are doing--whether they did go to a specialist that they were referred to, whether they bought their medications or not--and they're able to inform back to the primary care offices for better care coordination."

Evergreen has four affiliated primary care offices that serve 20 percent of its members; the rest use primary care physicians in the insurer's larger network of providers.

Its current arrangement is a far cry from where the startup was when it first began, according to Beilenson. In order to get off the ground quickly, the CO-OP initially rented a network of providers but couldn't share data with them.

Now that it has contracted with a sizeable provider network, he says, Evergreen is using its claims data to identify the members who could benefit most from interventions. Rather than focusing on its highest-cost members, though--which Beilenson points out are often past the point of care management--the CO-OP instead targets the next rung of high-cost patients, such as those who are overweight, prediabetic or smokers.

And the CO-OP has found early evidence that its approach is working. In the first six months of tracking the utilization and costs of diabetic patients who use Evergreen's affiliated primary care offices versus those who use its network of providers, the insurer has found the former are experiencing fewer emergency department visits as well as overall lower costs and better outcomes.

Those findings also point to another intrinsic advantage of Evergreen's affiliated practices.

"That allows us to do quality studies that you wouldn't normally be able to do without this tie-in," Beilenson says.

Claims data helps Maryland CO-OP Evergreen Health boost primary care