Leading Health Systems Poised to Partner with Managed Care Organizations on Value-Based Care Delivery and Payment Models, According to Findings from Decision Resources Group
August 27, 2014 – Burlington, Mass.
– Decision Resources Group finds that the intense physician acquisition activity that characterized the Memphis health system and hospital sector in recent years has given way to clinical integration, with rivals Methodist Le Bonheur Healthcare and Baptist Memorial Health Care pulling together their respective physician groups to coordinate patient care. In addition, a national contract recently signed between Tenet and Cigna, which has the most health plan enrollment in the Memphis market, sets the stage for pay-for-quality reimbursement arrangements and population health management programs that closely mirror accountable care organizations (ACOs).
Other key findings from the HealthLeaders-InterStudy Memphis Market Overview
Methodist Healthcare is approaching ACOs and other value-based care delivery and payment models through Health Choice, the health system’s joint venture with Memphis-based independent physician association MetroCare Physicians. Health Choice is evolving into a clinically integrated provider network that will serve as the exclusive contracting entity for both Methodist Healthcare and MetroCare Physicians.
MetroCare Physicians is converting from a messenger model IPA to a clinically integrated multispecialty group that will allow it to partner with Methodist to negotiate bonus pools with payers, as well as experiment with gain sharing reimbursement models.
Baptist Memorial is transitioning from a hospital-based system to a clinically integrated healthcare delivery network. Under new leadership, the health system is expanding Baptist Medical Group and rolling out a comprehensive electronic medical record system that connects all 14 Baptist-affiliated hospitals along with its clinics and financial systems.
Comments from Decision Resources Group Analyst April Wortham Collins:
“In many respects, the Memphis market is an ideal proving ground for healthcare reform. High poverty and unemployment rates, as well as a shortage of primary care physicians, contribute to disjointed care for a patient population with persistently high rates of chronic disease. Methodist and Baptist are attempting to address the problem by building out integrated provider networks spanning a wide range of specialties, with a particular emphasis on cancer and cardiac care.”
“With the clinical and technical pieces falling into place, look for Baptist and Methodist to move quickly to partner with commercial payers on value-based contracts, although it will be a couple more years before either is prepared to take on financial risk for patient outcomes.”