Last month, Anthem Blue Cross in California (a division WellPoint) announced it is entering a nonexclusive partnership with seven competitive hospital systems in the Los Angeles area. The new venture is called “Anthem Blue Cross Vivity,” which will offer a network of 6,000 doctors and 14 hospitals in total.
Some say Vivity is novel, bold, and game changing. What is it? An HMO or an ACO? Or something else? How will it work? Below are some notes (all quotes) from several sources, that partially inform these questions.
Quotes of Reed Abelson:
- The partnership includes such well-known medical centers as UCLA Health and Cedars-Sinai. […] Other hospitals in the new joint venture are Good Samaritan, Huntington Memorial, MemorialCare Health, PIH Health and Torrance Memorial Health.
- [The ambition is to provide a] level of coordinated, high-quality and efficient care that is now associated with only a handful of integrated health systems like Kaiser Permanente in California, Intermountain Healthcare in Utah and Geisinger Health System in Pennsylvania.
- [Vivity] will be offered to large employers beginning in 2015 at what Anthem estimates could be 10 percent less than what they are already paying for coverage.
- [A goal of Vivity is to] aggressively manage care.
- The hospitals must meet certain quality standards to ensure that they are not stinting on care. [They are expecting to] produce significant savings and profit by reducing unnecessary tests and unneeded hospital and emergency room admissions.
Quotes of Melanie Evans:
- [Vivity] will seek to replicate Kaiser Permanente’s success in controlling costs and ensuring quality—but without the singular ownership Kaiser has over its insurance and provider arms.
- Vivity seeks to compete head-to-head with Kaiser—the Oakland-based integrated delivery system that holds the largest share of the California employer market—as well as Health Net and Blue Shield of California, which also offer HMO and other narrow-network products.
- Employers will pay a capitated payment for each enrollee [in Vivity]. There will be no deductibles or coinsurance, and copayments for medical services will be modest.
- Vivity’s partners will pool premiums into one budget. Partners share equally in profits and losses. Partners that fail to meet quality targets won’t earn profits.
- [Participating hospitals will] move to meld their health IT systems.
Quotes of Bob Herman:
- [Vivity] will blend both the past and future as its planned HMO-like structure also looks to implement elements found in today’s accountable care organizations.
- Vivity will walk and talk like an HMO [… but] will also hold a structure similar to ACO.
- The plan will use a capitation model, essentially assigning a fixed per-member per-month figure to each beneficiary. Administrative costs and other expenses will be subtracted from the premium risk pool, and if costs are kept in check, all the founders will see profits.
- Reimbursement will be risk-based, meaning payment will depend on how well systems perform in certain quality measures, which have yet to be determined.
- The California Public Employees’ Retirement System, a group that negotiates health benefits for state employees and is one of the largest purchasers of health coverage in the county, has signed on.
- [To pass scrutiny by antitrust regulators t]hese types of “horizontal integrations” require evidence that other payers are [not?] losing access to the providers in question.
Quote from John Tozzi:
- Medical providers and insurance companies in California may have another reason to collaborate to hold down costs: The state insurance commissioner may get the power to reject premium increases if voters approve a ballot measure called Prop 45 in November. A state-imposed ceiling on insurance premiums could limit how much hospitals can charge. For hospitals and insurance companies, sitting down and figuring out how to cut some costs voluntarily—and share in the savings—is a much more palatable option.