Wilmington Health is taking a step outside of the traditional provider role of treating patients and being reimbursed by insurance companies or the government for those visits.
The group this year launched a service that puts them closer to the payer end.
Wilmington Health’s Anchor Senior Care Advantage is administered by the physician group partnership.
The value- based program focuses on Medicare Advantage patients, with the benefits Medicare patients look for when they sign up for additional coverage through an insurer, but with coordinated care offered by Wilmington Health.
The physician group is working on it with California-based Agilon Health, which has set up similar practice-branded joint operating models around the U.S. and is in 11 markets, according to the firm.
Together, Agilon and Wilmington Health are responsible for all of the costs assisted with the patients assigned to the practice under the program, Wilmington Health CEO Jeff James said.
“We get a percentage of the premium dollar,” he said. “We’re not technically an insurance company, but it does shift the burden to us.
“It provides significant flexibility in caring for our patients,” James added. “There’s multiple new programs that we could take advantage of as well as redesigning some of our relationships with some of the other providers that work with us.”
For participants, it means each patient is attached to a personal physician who leads a team of providers that follows the person’s care in a coordinated way, instead of treating a patient’s needs as they come up.
It’s a similar approach to how accountable care organizations developed in which the federal government gives participating providers incentives for improving overall health measures while containing costs through coordinated care.
But unlike with ACOs (both Wilmington Health and NHRMC have them), in which it can be difficult to know whether providers will hit the benchmarks to receive shared savings money back, “this model, we know what the resources are,” said David Schultz, Anchor's medical director.
“In this model, the physicians have a 360-degree view of the health care of a patient,” Schultz said. “Those are kind of the ways from a physician point of view that we can provide really good care to patients, and that ends up being a good financial model for us.”
He said it gives more control to physicians.
“That’s the interesting thing about it to me, is that it gives physicians a whole bunch of ability to do things for our patients that we couldn’t do in fee-for-service,” Schultz said, “where we kind of feel knocked around by insurance companies.”
While Wilmington Health launched the program earlier this year, James said they spent much of that time getting the infrastructure in place. “We really expect the first year of growth to be next year – 2021 – and this year to be more of an operationalization of our plan,” he said.
They anticipate having about 6,000 patients enrolled by the end of this year and close to 10,000 patients next year, Schultz said.
To fall under Anchor Senior Care Advantage, patients have to be enrolled in a participating Medicare Advantage plan and sign up to pick one of Wilmington Health’s primary care physicians to oversee their care. The Medicare Advantage insurer also could assign patients to the program.
James said they partnered with Agilon after seeing the work it was doing with independent physician groups in other parts of the country.
“We were able to look at the successes that they were having in modeling our own program,” he said.
“What it does is it takes the core competencies that we’ve been working on for a decade now very successfully, and sort of provides some professional guidance in this one area, which is Medicare Advantage.”
Limitations because of the coronavirus hampered more in-person market events to explain the new program to area seniors, though the group has online information sessions about Medicare coming up through its website.
They also are planning to publish a 2021 calendar stemming from a 60 Strong Ambassadors contest that Anchor Senior Care Advantage held recently to spotlight local seniors picked for their achievements and impact on the region.
To see the winners go to anchorseniorcareadvantage.com/contest