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Clinically Integrated Network Wants to Collaborate with Payers

By Philip Betbeze  
   June 12, 2015

"The economic well-being of our region is dependent on communities that have strong education and healthcare to support a vibrant business community," Cianciolo says. "A large part of why we came together was really to keep the payers interested by aggregating enough of a population—enough lives—that the state and national insurers stay interested in collaborating with providers to improve the health status of our communities across the region. Together, we can tackle the health challenges of the mostly rural South. We have similar populations in terms of health issues—including a higher incidence of obesity and diabetes."

These chronic conditions contribute to the South’s ranking in the seven of the bottom 10 states for health as rated by the United Health Foundation. Not exactly a great foundation for health insurance companies, but possibly a great opportunity for collaboration with VHAN to improve health, thus demonstrating value.

Rural America is Hazardous to Your Health

The idea is that the VHAN allows local relationships and local decision-making, especially clinically, to be maintained while saving money on duplicative back office functions. It also creates a vehicle to manage the health of a population or many different populations through population health management capabilities and even, quietly, through benefit services for both fully insured and self-insured employers.

"It is about managing populations in the future," says Cianciolo. "For an insurer, the cost of acquiring a life is significant if you're in rural markets. You can't just go to a big city and get a small portion of market share."

Besides that, Cianciolo adds, in many of these markets, you start with a sicker population that already has high utilization rates. Often, without a mechanism to bundle patients (for lack of a better term) to create a larger population under the same care management protocols, you end up with suboptimal solutions.

"So if you're one of the state or national insurance companies, we want you to stay invested in the region," Cianciolo says.

Cianciolo says that if VHAN is able to aggregate lives, as is its plan, and if it can create opportunities to work together for certain purposes, VHAN can keep payers’ interest.

"We've been having discussions with the CEOs and CFOs of some large payers, and I think that it makes sense to them if you can bring half a million lives aggregated across these markets," he says. "Then, we will have a chance to have very different opportunities to collaborate and provide innovative, cost-effective solutions.

Philip Betbeze is the senior leadership editor at HealthLeaders.

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