Tennessee IPA Leader Explains Importance of Value-Based Care Partner

Phoenix-based Equality Health offers value-based care solutions dedicated to serving independent primary care practices in closing gaps in care. Last June, I had the opportunity to interview Mark Stephan, M.D., M.B.A., the company’s chief medical officer, about Equality Health’s ’Medicaid-first” business model.

“The way we enter markets is in the Medicaid space, but we also have Medicare Advantage contracts and we're in ACO REACH,” Stephan told me. “It’s important to bring a portfolio of value-based agreements to a practice. It helps with mindshare and behavior change and practice transformation when you have a significant part of your panel in a value-based agreement.”

In December I had the chance to hear more about how this plays out from the physician practice perspective by talking to Victoria Blanken, executive director of Highlands Physicians Inc., a 1,400-physician independent physician association in east Tennessee and southwest Virginia.

I asked Blanken what was attractive to Highlands about working with a company like Equality Health. 

First, she said, Highlands runs as a very lean organization, and most of its profits go back to the physicians to help them maintain their financial independence. Among the many challenges her office faces is working with more than 40 different EHRs, but she said Equality Health is working to integrate data from those EHRs into their Care Empower software.

“We look at it as an obligation to make sure that we help our neighbors in need. For two of our counties, the poverty rate is almost 15 percent, which is above the national average. We needed a partner that could bring not just technological pieces and solutions to us. We needed the ability to have more funding for the human resource we needed, more boots on the ground, if you will, in these communities,” Blanken said. “Equality Health’s business model involves hiring local residents to work in our community-based organizations to make outreach calls. That was so very important to my physicians in a market where mergers and acquisitions are taking place at alarming rates. Even though our partner is based in Phoenix, we still feel like Equality Health is a local partner to us, because that's how they make you feel by hiring local people offering support.”

She described how Equality Health redeveloped its cultural care training model, which had been largely geared toward Hispanic populations, to represent the Appalachian Highlands area. “That’s a phenomenal partnership when you have a partner that meets you where you are, and meets your community members where you are.”

Historically, she said, Highlands' physicians never made money in the Medicaid space. But they continued to work in it because they believe it is their obligation. “Equality Health gives us the ability to be financially sustainable and take care of our population that needs it the most,” Blanken said. 

Before partnering with Equality Health, Highlands had already begun to add care coordinators and community health workers on a small scale, she noted. “But now our partnership with Equality Health has allowed us to expand that so that we're really taking care of the population. You have to stratify risk. Equality Health has allowed us to expand that so that we're taking care of more people.”

 I asked if that has resulted in savings from fewer emergency room visits or hospitalizations.  

Blanken said that because they have only  been working in this space for a little less than a year, it is too early to share quantitive data.

Joining our conversation was Larry Green, Tennessee market president for Equality Health. Before joining Equality, he has served as an executive with health systems such as Ascension Health, Advocate Aurora Health, and HCA Healthcare. He has focused on various risk-based financial reimbursement mechanisms as well as building value-based care models, clinically integrated networks, and accountable care organizations.

I asked Green if there was something about Tennessee that was appealing to Equality Health as a market to enter. 

“Tennessee was advanced with regard to alternative payment models. They were far along in terms of the value-based care journey juxtaposed with some other states,” he replied. “There was regulatory alignment and there was a real growth opportunity. Also, several of the health plans have a health equity focus. WellPoint has been recognized for their work in the health equity space as well as Blue Cross and Blue Shield of Tennessee. Also, there are somewhere between 500,000 and 600,000 Medicaid enrollees who reside in rural Tennessee. That was an intriguing element to move into Tennessee and to begin our work in East Tennessee with Vicki and Highland more broadly.”

Blaken said her group is using Equality Health’s Care Empower software to benchmark the patient — what their HCC [Hierarchical Condition Categories] score was and how many times they were able to get into their primary care physician. “We’ll look at those measures and see if we can improve them,” she said. “Because of the agreement we have with Equality, our contracts with the managed care organizations are much better than they would have been were we not with a value-based partner in this space that had a history of being successful in managing their patients. So even from the beginning, the contract negotiations were better.”

Changing subjects and speaking from a policy perspective, Blanken said more needs to be done to support rural providers. “We’re withering on the vine out here,” she said. “There have been 16 hospital closures this year and 13 of those are rural. Tennessee was the second-largest for hospital closures in rural areas.”

The merger and acquisition market has made it increasingly difficult to remain independent, she added. “The IPA has helped independent physicians stay independent. But we've seen an alarming number of practices move into larger practices or multi-specialty practices simply because they can't afford to keep their doors open. Between that and the hospital closures, I don't have to tell you how vitally important it is to find a solution to this problem.”