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Many agree that the current healthcare system is too expensive, and it's this belief that has prompted a new collaboration between HighMark Health and ChristianaCare, which will aim to make healthcare more affordable by taking costs out of the system.
Through a new joint venture company, these two organizations are combining to create a new model of value-based care that is continuous and data- and technology-led. The groups promise that the new model will be a "radical departure" from the transactional, fee-for-service model that underpins much of American healthcare.
The new joint venture does not represent a merger or an exclusivity agreement between ChristianaCare and Highmark. Both organizations will continue to operate independently in their respective markets.
WHAT'S THE IMPACT
Value-based care, of course, pins reimbursement more to clinical outcomes than to volume, and has been seen as an avenue for increasing care quality. It's a model of care that incentivizes outcomes and efficiency, and both Highmark and ChristianaCare wanted in on that space, claiming that American healthcare is too often a tug-of-war between payers and providers, rife with inefficiencies and misaligned incentives.
The companies' value-based care model will emphasize a modernization of care delivery so that care doesn't necessarily revolve around an appointment from a doctor. It will focus on data and technology, including wearable technologies, virtual healthcare visits and telehealth, secure texting and data-powered care management.
To start, two engines will power the creation and delivery of new care models under the partnership. The first is the Solution Design Center, which will create data- and technology-driven solutions for patients, members and providers. The second key is the Center for Virtual Health, which develops, tests and deploys virtual capabilities for primary and specialty care. This, the organizations said, improves patient access, experience and outcomes while reducing the total cost of care.
ChristianaCare and Highmark Health have committed to a 10-year joint venture, with oversight by a board equally comprised of leaders from both organizations.
The partnership's most immediate impact will be in Delaware, where ChristianaCare and Highmark's Delaware health plan affiliate are already involved in value-based care. The two organizations partnered in 2019 in a value-based payment agreement to improve the health of Medicaid patients in the state.
THE LARGER TREND
As value-based arrangements become more common in the U.S. healthcare system, leaders now must figure out how they are best implemented. Whether it's through a health system contracting outcomes-based agreements with insurers, through networks of independent practices or through accountable care organizations, what matters is that patients are getting the best care for their money.
The Centers for Medicare and Medicaid Services has recognized the need for value-based care and has begun making it easier for states, drug manufacturers and commercial payers to make agreements.
In 2020 it issued a final rule that promotes value-based drug purchasing agreements. The rule promotes value-based purchasing arrangements by allowing for negotiations around drug prices to be based on evidence-based outcomes such as reduced hospitalizations, lab visits or physician office visits -- which ensures that if the drug is not effective, the payer is not held accountable for the full price, CMS said.