Washington, DC (PRWEB) April 02, 2014
In a move that one industry observer calls the “tip of the iceberg” and that a WellPoint, Inc. executive terms a “new strategy” for its CareMore Health System unit, CareMore and Emory Healthcare said March 19 that they will work together to serve Medicare Advantage beneficiaries in Georgia. In an interview appearing in the March 27 issue of Atlantic Information Services’s Medicare Advantage News (MAN), CareMore CEO Leeba Lessin said that unit is in negotiations in five other states about similar arrangements and expects to have one additional deal in place in “the coming weeks.”
The kinds of arrangements outlined by Lessin are not like deals that surfaced in recent years in which insurers helped providers start MA plans. Indeed, she noted, Emory won’t be starting an MA plan. Emory instead will be working with three existing MA plans — including WellPoint’s Blue Cross and Blue Shield of Georgia unit — and will both purchase services from CareMore and share risk and savings with it.
While this is a different role for CareMore than what WellPoint’s prior management envisioned when it agreed to acquire CareMore two years ago, it makes sense in the current environment of declining MA plan payment rates and heightened need for close provider-insurer ties in MA, Lessin told MAN. And, she continued, it could lead to CareMore starting new MA institutional or chronic care Special Needs Plans with provider systems as early as 2016.
Richard Zoretic, president of WellPoint’s Government Business Division, told the company’s Investor Day audience that the deal is an example of a new CareMore strategy to “unlock its value” via an “opportunity to export” its model by partnering with provider systems that want to take risk. CareMore is not just an MA plan operator; it is also a “delivery system,” he asserted. Zoretic noted that Lessin herself drove the Emory deal, and said this agreement could become the template for arrangements with other providers.
Dan Lyons, M.D., CEO of Skippack Creek Consulting, LLC and medical director of provider-owned AtlantiCare Health Solutions, pointed to data analytics as an area in which CareMore can help Emory. Those data analytics can get clinicians more focused on appropriate care and can make Emory a more attractive option for MA patients, said Lyons, and it means Emory won’t have to meet the kind of licensure and capital requirements it would confront if it entered MA by itself.
Lyons, who called the Emory-CareMore deal potentially “the tip of the iceberg,” said it makes great sense for CareMore as well. There are “very limited opportunities for new bricks-and-mortar” MA facilities given the industry’s financial climate and the “mature” nature of the MA market, he told MAN, adding that “everybody on the MA side is worried about payment adequacy.”
Visit http://aishealth.com/archive/nman032714-01 to read the article in its entirety, which examines the deal in depth and covers the industry’s reaction to it.
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