Provider-Sponsored Health Plans
Why Now Might Be the Time
Competition among healthcare providers and increasing pressure to lower costs are driving health systems to consider moving toward value-based care. For many hospitals and health systems, provider-sponsored health plans (PSHPs) designed for their specific patient populations represent an opportunity to better align incentives, increase clinical coordination, diversify revenue and reach more patients. PSHPs enable health systems to take full responsibility for their patients—from designing a specific care plan to working with physicians and patients to implement it.
Full Responsibility Requires New Capabilities
The idea of stepping into payors' shoes can be overwhelming, but the rewards far outweigh the risks. Valence Health's complete solutions enable provider organizations to swiftly and successfully design, implement, and operate a "high value" PSHP. Whether capabilities are employed in modules or as a whole, Valence's end-to-end services include consulting expertise, a proprietary technology platform, and all the required clinical, actuarial, and operational capabilities to take you from a standing start to full PSHP operability.
How Can We Help?
Evolent Health, Inc. (NYSE: EVH), a company providing an integrated value-based care platform to the nation’s leading health systems and physician groups, announced today the completion of its acquisition of Valence Health. First announced on July 13, 2016, this strategic acquisition brings together two innovative companies that serve health care providers in the transition to value-based care.
Jointly sponsored by Eskenazi Health and Indiana University Health, MDwise, an Indianapolis-based company, serves more than 400,000 members and is among the nation’s largest provider-sponsored Medicaid plans. MDwise, established in 1994, has a broad network of doctors and hospitals and was the top-rated Medicaid HMO in Indiana according to National Committee for Quality Assurance (NCQA)’s Medicaid Health Insurance Plan Ratings 2015–2016.
Valence Health, a leading provider of clinical integration, population health, and value-based care solutions and services, today announced its partnership with Memorial Hermann to help administer and support the system’s soon to be acquired Medicaid health plan. Late last month, Memorial Hermann Health System announced that it had entered into a definitive agreement to buy an existing Medicaid plan from Molina Healthcare. The acquisition is expected to close during the second quarter of 2017 subject to the receipt of regulatory approvals and the satisfaction of other closing conditions.