Need to Know: July 2014


Industry updates in business, health management


Aetna and Northeast Medical Group (NEMG) have a new contract addendum that will facilitate improved care coordination and care quality for Aetna members while lowering overall cost of care. Through the collaboration, Aetna will provide NEMG physicians with information to support more patient outreach and reward NEMG on measures of patient care. The contract became effective on July 1.

IPC, a national hospitalist physician group, has expanded its presence in the Houston market with the acquisition of Total Inpatient Services (TIPS). Based in Sugar Land, Texas, TIPS physicians practice in both acute care and post-acute facilities. Cofounder Mark Murray, MD, will remain with the practice in a leadership position. IPC physicians operate in 400 hospitals and 1,200 post-acute facilities across the United States. 

Health Management

Four more Michigan healthcare systems have agreed to participate in Blue Cross Blue Shield of Michigan’s value-based reimbursement model, helping hospitals coordinate patient care and manage population health. Forty-five hospitals now participate in the model. Newly added are Detroit Medical Center, Allegiance Health, Dickinson County Healthcare System and Metro Health Hospital.

Independence Blue Cross’s primary care doctor network now has more than 300 patient-centered medical homes (PCMHs). About 1,550 doctors serve 43% of Independence members- one of the highest concentrations of medical homes. Independence offers a direct financial incentive to any primary care office which becomes recognized as a PCMH by the National Committee for Quality Assurance.

Results from the Healthways SilverSneakers Fitness 15th Annual Member Survey of more than 35,000 respondents in 50 states show that today’s older adults are more active and dedicated to fitness than previous generations. Respondents are seeking fitness options in record numbers and are diligent in their fitness routine with 82% of participants doing aerobic activity three or more times per week. Additionally, 50% of respondents cite an improvement in chronic disease conditions resulting from their active lifestyle.

McKesson and ValueOptions have formed Nevada Medicaid’s Health Care Guidance Program, which provides integrated physical and behavioral care management for Nevada Medicaid members. Expected to serve up to 41,500 individuals, the program will provide solutions for high-need enrollees who are facing chronic medical conditions, have persistent mental health or substance use disorder conditions, or demonstrate high service need. McKesson will coordinate the program’s physical health services while ValueOptions will manage the behavioral health component.

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