Will ACOs Usher in a New Era of HMO-Style Managed Care?

Amber May has published an article on BenefitsPro.com that recalls a time in the 1990s when HMOs were the biggest thing in health care. She points out that the most obvious benefit of an HMO system is the coordination of care the organizations facilitate and how, since 1995, the National Health Insurance Law in Israel made participation in one of the four Israeli HMOs compulsory for all Israeli citizens.

May points out that once again the United States is experimenting with managed care. She notes that the Patient Protection and Affordable Care Act (PPACA) is attempting to address the lack of care coordination that’s developed in the American health care system by creating provisions for accountable care organizations (ACOS), coordinated groups of health care providers that provide care for specific populations of patients and are accountable for the quality, cost and outcomes of that care.

She notes that through PPACA, ACOs are tied to Medicare and speculates that a universal managed care system similar to Israel’s may be a long way off for the U.S. – To learn more see benefitspro.com.

New Horizon Blue Cross Blue Shield of New Jersey Product Brings Innovative Accountable Care Model to Employers

Newark, NJ – November 7, 2013) – Horizon Blue Cross Blue Shield of New Jersey (BCBSNJ), which has been leading an effort with physicians, hospitals and health care leaders throughout the state to transform how health care is delivered, has developed a new product for employers to encourage employees to use physicians focused on improving the value of care patients receive, rather than the volume of care. The goal of the new product is to increase the number of Horizon BCBSNJ members who will seek care in patient-centered practices to improve patient outcomes and reduce overall health care costs.

The new product – the Horizon Patient-Centered Advantage EPO Plan – is now being offered to fully-insured employer groups for coverage that becomes effective on January 1, 2014.

Aetna and Sharp HealthCare Expand Accountable Care

SAN DIEGO–(BUSINESS WIRE)–Aetna announced an accountable care collaboration and the introduction of Aetna Whole HealthSM, a new commercial health care product that provides members access to highly coordinated care from physicians and facilities in the Sharp HealthCare system. The new product, effective February 1, will be available to self-insured and fully insured businesses with greater than 100 employees who reside in San Diego County.

An accountable care collaboration is a group of health care providers who assume responsibility for the quality and cost of care for a group of patients. Aetna members will receive an enhanced level of coordinated care in addition to the member benefits of their current Aetna plan.

See the full story at Aetna.com

University of Utah Health Plan Launches Accountable Care Program with Value Based Payments to Providers

Salt Lake City, UT – Officials at University of Utah Health Plans (UUHP) have unveiled the Accountable Care Program, which will serve 56,000 members in Utah. The new program includes a partnership for value based payments between the health plan and the University of Utah Primary Care Physicians Group and is the first Medicaid ACO plan to accomplish this in Utah.

As part of the program, University physicians will monitor and coordinate all aspects of an individual’s medical care. This means patients with chronic conditions like diabetes will see one provider who will coordinate all that patient’s needs, such as diabetes care, eye care, and skin care.

See the full story at UhealthPlan.Utah.edu

Simply Healthcare Plans of Florida Gets Equity Investment.

MBF Healthcare Partners, L.P. (MBF), a healthcare services focused private equity firm, announced its plans to invest up to $50 million of equity capital to support Simply Healthcare Plans of Florida, Inc. (SHP) an HMO based in Coral Gables, Florida.

The equity investment will be used to fund expansion and acquisition efforts in Medicare and Medicaid.  SHP is a licensed HMO in Florida that has been approved by the State to expand into the Medicare and Medicaid markets.  MBF is sponsoring a seasoned managed care team that is led by Peter Jimenez an exceptional executive with a long track record of value creation in managed care that has been credited with the success of two large HMOs in Florida, Physician Healthcare Plans, which was sold to Amerigroup Corporation in 2002 and Care Plus Health Plans, which was sold to Humana in 2005.  SHP is aggressively pursuing acquisition opportunities throughout the country while expanding its current operation and capabilities in Florida.

Mike Fernandez, Chairman and CEO of MBF said, “I believe that the current healthcare environment in the United States presents an opportune time to build and expand managed healthcare services. We believe that managed care can be an integral part in coordinating high quality healthcare services while controlling fraud and abuse in the healthcare system in State and Federal funded programs.  In addition, we believe that Medicaid will play an integral part in the Federal Government’s efforts to expand healthcare coverage to the uninsured population and that Medicare Advantage plans will continue to expand as the baby boomers reach the Medicare eligible age.  Well run managed care plans have proven that they can offer high quality services and benefits to its members while providing State and Federal government with predictable costs.   We are extremely fortunate that we have been able to assemble a team of senior executives who have a proven track record of success in managed care.  Peter Jimenez who is leading our executive team is an exceptional executive and we look forward to collaborating with him to capitalize on the opportunities created by the recent developments in the healthcare market. Our partnership with Peter and his executive team reflects another example of MBF’s current strategy in a changing private equity market to identifying highly attractive segments in healthcare services and partner with outstanding executives.”

About Simply Healthcare Plans, Inc.:

Simply Healthcare Plans, Inc., headquartered in Coral Gables, Florida, is a licensed HMO focused on providing Medicare Advantage and Medicaid managed care solutions and services.