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State of Connecticut’s New ‘Episodes-of-Care Health Plan’ Could Be Key to Scaling Value-Based Care

By JESSICA DaMASSA, WTF HEALTH

Signify Health (NYSE: SGFY) has called their approach “Value-Based Care 2.0” and, today, they’ve received an important designation from CMS that could set an exciting precedent for scaling up episodes-of-care, value-based models for the under 65 commercial health insurance market. The plan to receive this important approval as an Advanced Alternative Payment Model (AAPM) is the State of Connecticut’s health plan – a massive plan that covers the State’s 220,000 employees and retirees. To talk about what this first-of-its-kind approval signals for the future of value-based payment models are the State of Connecticut’s Comptroller Kevin Lembo and Signify Health’s CEO Kyle Armbrester.

What’s so important here is the combination of episodes-of-care (which is like value-based care-lite) and the under-65 market (which is not as rich with value-based care case studies as the over-65 Medicare market). That a State government with a massive population of covered lives AND a vested interest in helping keep local hospitals and health systems vibrant economic engines in the community is leading the way on this novel payment model design is significant. And, Comptroller Lembo gives us the details about how he’s viewing it as a win-win – after quite a few battles along the way. To win in health innovation, you’ve got to follow the dollar! Tune into this chat to see where it’s headed as episodes-of-care models get a huge boost from CMS.

Will ‘Digital-First’ Health Plans Usher in Telehealth At-Scale? | Danielle Russella, American Well

By JESSICA DAMASSA, WTF HEALTH

Is healthcare on the way to ‘telehealth at-scale?’ We checked in with American Well’s Danielle Russella, President & GM of Health Plan Solutions, to rumor-check the buzz we’ve been hearing about “digital-first health plans” and what that means for the future of health plan coverage for telehealth services. From provider uptake and payment parity to patient awareness and utilization, Danielle weighs in on the state-of-play of telehealth/health plan relations and how digital health seems to finally becoming part of payer strategy talks within the C-suite. At American Well, that’s meant more growth in last 2 years than in the previous 8 years, says Danielle. Is that why we’re hearing those IPO rumors? Tune in to find out if there’s any merit to that chatter.

Filmed at HLTH 2019 in Las Vegas, October 2019.

Health Plan Innovation Gets a ‘New Look’ | AHIP’s CEO Matt Eyles

“I don’t know that what they’re doing is going to be as transformative as maybe the potential of it is – and it’s going to take time. I don’t know that they’re going to ‘all-of-a-sudden’ leap frog over all the things that health plans have been doing for decades. I think they’re going to learn that this is really complicated stuff…” 

Health plan innovation got a makeover this year. What used to look like value-based care models and telehealth visits has transformed. Health plan innovation is sexier – with big-dollar M&A deals like CVS-Aetna and Cigna-ExpressScripts looking to flatten the industry. Meanwhile, brand name collaborations like Amazon-Berkshire Hathaway-JP Morgan may prove that payment model innovation is unexpectedly ‘label-conscious.’

So, how are health plans dealing with this startling new look? And what should health tech startups who want their innovation investment dollars do now??

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