From Volume to Value – Why Provider-Led Organizations are on the Rise

As healthcare evolves, reimbursement models continue to shift from volume to value. That means more providers are taking risk and moving into value-based reimbursement models. One such model is the Accountable Care Organization (ACOs) in which the provider has accountability for achieving quality improvements and spending reductions.

ACOs are not the only model. In today’s market, providers often form and/or contract with entities such as Managed Services Organizations (MSOs), Clinically Integrated Networks (CINs), or Independent Physician Associations (IPAs). For providers, the benefit of these organizations is clear: they supply the infrastructure and tools to be successful in meeting quality and cost targets required for their value based contracts. The result is better care for patients (especially the chronically ill), reduced waste and inefficiencies and financial incentives that are structured on quality benchmarks. ACOs, MSOs, CINs, and IPAs all incentivize primary care providers (PCPs) to improve the health of their entire patient population.

There are hundreds of these organizations across Medicare, Medicaid, and Commercial lines of business and many are executing value contracts and already realizing shared savings for primary care.  As they come together, the providers develop increased access to enhanced technology and expanded patient reach.  As these organizations mature, they are also beginning to engage specialists in value initiatives.

Magellan’s view of value is Specialty Care

To support value in specialty care, Magellan has developed a provider solution that is centered on behavioral health and physical health integration. It is designed specifically for provider organizations to successfully manage population health and take on risk under value based reimbursement through clinical, operational, and digital capabilities. Program components support the entire continuum of care and include:

  • Screen & Engage: More accurate diagnosis through tools that are embedded into the primary care practice workflow
  • High Performance Networks: Increased access to providers with improved quality and efficiency scores who embrace the vision of population health and support value based payment
  • Case Management: Collaborative approach with warm hand-offs between the primary care office to Magellan to drive better outcomes
  • Collaborative Care Model: Team-based integrated behavioral healthcare driven by Magellan expertise and digital screening capabilities to track patient progress and treat to target
  • Authorization Support, Concurrent Review  & Transitions of Care: Discharge planning and case shaping to support patients transitioning from an inpatient facility to their home
  • Telehealth: Increased access to care through a network of telehealth providers and text therapy providers
  • Other Digital Solutions: Digital Cognitive Behavioral Therapy (D-CBT) for patients that is integrated with Magellan’s Smart Screener

In addition to the core solution set, Magellan has a comprehensive suite of behavioral health, specialty, and pharmacy products that can be customized for provider organizations. Magellan also supports providers in developing accountable care organizations for complex specialty care such as cardiac conditions. This approach supports and incentivizes cardiologists to proactively managing patients to improve quality and reduce costs. Magellan recently entered into its first specialty ACO relationship and will continue to develop and launch these types of relationships.

 

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