There has recently been significant attention on the role of new players in the healthcare market — both nontraditional healthcare investors and providers entering into the delivery of care spectrum as well as traditional players taking on new roles. One prominent example in the latter category is the changing role of the payor, which we’ve seen move from simple reimbursement party for traditional fee-for-service care to a more active participant as acquirers of providers and partners with providers in large-scale arrangements ostensibly aimed at driving down costs while increasing quality.
Some examples of payors investing in/acquiring providers include UnitedHealth Group acquiring Monarch HealthCare, an Irvine, Calif.-based independent physician group, in 2011; Highmark, a Blue Cross and Blue Shield licensee in Pennsylvania, acquiring West Penn Allegheny Health System, a financially troubled hospital system in Pittsburgh, in 2013; Humana acquiring Concentra, an urgent- and occupational-care provider, in 2010;Humana acquiring SeniorBridge Family Cos., a provider of in-home care for seniors, in 2012; and WellPoint acquiring CareMore Health Group, a Medicare Advantage plan that operates numerous neighborhood care centers.
Alternatively, one recent example out of the dialysis industry shows the value payors are seeing in an arrangement that isn’t a true investment/acquisition but does align large providers in significant ways with payors. In April, Highmark announced a partnership with kidney care services provider DaVita. Under the terms of the partnership, DaVita will provide an integrated care-management program designed for Highmark’s members with end stage renal disease. As the Pittsburgh Business Times reports, if DaVita meets the National Kidney Foundation’s metrics of quality care treatment criteria for kidney failure patients and does so while keeping down care costs, Highmark will split the resulting savings with the DaVita.
“We want to work with providers to pay for value,” said Robert Wanovich, Highmark vice president of market strategy & delivery, in a news release on the DaVita partnership. “This new, shared-savings program is a good example of a collaboration where both companies can benefit and ultimately deliver better care to the member.”