Humana Inc. says it has seen the future of Medicare Advantage, and it looks quite a bit different from what MA looks like today. When the company on Nov. 5 unveiled the planned acquisition of Metropolitan Health Networks, Inc., a Florida-based medical services organization, and purchase of a noncontrolling interest in another MSO and of a health IT firm that links physicians, it made a point of saying they are parts of a new integrated care delivery strategy in Medicare.
In some ways, this kind of a strategy has been tried before with decidedly mixed results. Hospital system-owned plans either in MA or its Medicare+Choice predecessor often stumbled over the opposite incentives of the two entities — hospitals wanting more patients, and health plans wanting to avoid the high costs of hospital care. But the kind of integration Humana now is looking at is different — and so are the times. The company is focusing on primary care physicians (PCPs), as was WellPoint, Inc. in its CareMore acquisition last year, seeing that as the key piece in improving patient outcomes — and boosting its CMS star quality ratings (and thus bonus payments) in the process.
Is Humana’s approach, which the company said it expects to extend to acquiring more MSO “assets” and 300 to 400 more PCPs next year in a total of “six targeted markets,” a right one? Are we going to see a new wave of MA plans buying PCP practices? And will PCPs and MA plans be able to co-exist beneficially in this modified “back to the future” approach?
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