United Healthcare and Aetna offer Apple Fitness+ to members
UnitedHealthcare will continue to offer free Apple Fitness+ subscriptions to members with employer-funded health plans, and Aetna will offer a free subscription to Apple Fitness+ to its 3.2 million Medicare Advantage members through Tivity Health starting next year.
Cigna develops vitality index to measure overall health
Cigna unveiled a new “vitality index” designed to measure multiple areas of population mental and physical health.
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Our focus is investigation, identification, insights, incubation, and implementation of innovative ideas that advance equitable, value-based care. For example, we’ve collaborated with clients to 1) Build new VBC-related product and service capabilities, 2) Corporate Strategy and Development, M&A, and Private Equity Funding, 3) Launch existing product in a new industry segment, and 4) Executive Leadership of Value-based Care Organizations.
About TripleAim Strategy Advisors
TripleAim Strategy Advisors is a management consulting firm, which collaborates with clients to improve performance and outcomes in the transition to equitable, value-based care.
We bring 25 years of health plan operations experience and 18+ years of providing insights and creating solutions focused on advancing equitable, value-based care.
Meet our Principal Advisor, Don Gerdts
Don Gerdts specializes in the identification, investigation, insights, ideation, incubation and implementation of innovative ideas that advance the transition to value-based care.
Health Plan acquisitions of Provider Groups improve Value-based Care
What should we make of the continuing trend of health plans acquiring provider practices, retail clinics and home-based/virtual care capabilities?
Consider some recent transactions:
1) CVS acquires Signify Health, Target Pharmacy, Omnicare, etc. (10,000 providers + expand Rx).
2) UnitedHealth Group (now 60,000 providers) acquires Healthcare Partners, Landmark Health, DaVita Health, etc.
3) United Health Care partners with Walmart Health.
4) Humana buys out Private Equity partner to expand CenterWell.
5) Elevance Health acquires CareMore, CareBridge, Amwell, etc.
Let’s put this activity into the framework I’ve established in this series to evaluate healthcare value, which is really a mathematical perspective of the Triple Aim, where:
Value = E[Q+S] / [∑(P*U)] or Value = Effectiveness [Quality + Satisfaction] / Total Cost
Substituting the stakeholder roles for the variables in the healthcare value equation, the result is:
Value = (People + Policymakers) / (Providers + Producers + Payers)
Now, evaluating the VBC equation through the lens of the stakeholder roles, we can better understand the rationale for Payers acquiring Providers and Producers, like those I listed above.
While Providers, Payers and Producers (like Pharma) drive the denominator of cost, they have an inverse relationship with Provider and Producers driving cost trend up (especially with public and private equity owning an increasing share) and Payers attempting to drive cost trend down for similar reasons.
I see two primary effects of Payers owning more Providers:
1) Better data sharing to the clinical workflow enabling value-based decisions, and
2) Reduced pricing pressure from Providers with more shifts to alternative provider compensation models, including risk sharing and salary + quality incentives.
Solving the Healthcare Value Equation – Part 3
Value-based care (VBC) is the goal of improving the quality of and satisfaction with healthcare while lowering overall cost. I’m proposing the following equation to identify the interaction of the key variables of value-based care: Value = Effectiveness [Quality + Satisfaction] / Total Cost.
Mandating the measurement of the quality of healthcare has provided a means to “comparison shop” health plans, and the average measured quality of care has increased over time, especially in government sponsored programs run by private health plans, like Medicare Advantage and Managed Medicaid). However, this desirable ability adds billions of dollars of cost annually to the healthcare system with much more required investment on the horizon.
In my opinion, quality mandates are needed to accomplish important national healthcare goals, but quality mandates do not help accomplish the triple-aim of CMS.
Solving the Healthcare Value Equation – Part 2
Value-based care (VBC) is the goal of improving the quality of and satisfaction with healthcare while lowering overall cost. I’m proposing the following equation to identify the interaction of the key variables of value-based care: Value = Effectiveness [Quality + Satisfaction] / Total Cost.
Evidence-Based Linkages between SDoH and Health Outcomes – Part 4
Don Gerdts highlights a study where Duke Cancer Institute has shown that social stress factors (SDoH, or social determinants of health) like access to care, racism, pollution, and the many problems associated with poverty have a direct impact on the cellular mechanisms that drive lethal, invasive forms of breast cancer, resulting in higher incidences and lower survival rates in Black women than White women.
Evidence-based Linkages of SDoH to Health Outcomes – Part 3
This study titled, “Association Between Self-reported Health-Related Social Needs and Acute Care Utilization Among Older Adults Enrolled in Medicare Advantage” found that certain social determinants of health were associated with statistically significantly higher rates of acute care utilization, which included >50% increases in avoidable hospital stays and emergency department visits.
In the population of over 56,000 Medicare Advantage beneficiaries, almost 50% reported one or more health-related social needs (HSRN). The exposures evaluated included food insecurity, financial strain, loneliness, unreliable transportation, utility insecurity, housing insecurity, and poor housing quality.
While these risk factors do not stand alone the study identifies the significant role of specific social exposures in determining the increased incidence of avoidable hospitalizations, ED visits and 30-day readmission rates. These results negatively affect the Triple Aim of value-based care by increasing cost of care without improving quality or outcomes.
Understanding how different HRSNs relate to different health outcomes can inform targeted, evidence-based policies, investments, and innovations to address specific social determinants of health without “medicalizing” them.