Health Policy$ense

AcademyHealth Panel: Private Sector Alive and Well in Health Care

Private Sector Initiatives in Patient-Centered Homes, ACOs, Bundled Payments and More

As a recipient of the Alice Hersh Scholarship, I had the privilege of attending AcademyHealth’s 2015 National Health Policy Conference in Washington D.C. In addition to many interesting sessions, I had the opportunity to meet many leaders in the health care space, from health services researchers and policy makers to providers and business leaders. One of the most interesting themes throughout the conference was the developments and innovations in the private sector.  

Similar to recent moves by other national retail chains, Walgreens will continue its push towards being a major player in health care as described by Jeffrey Kang, Senior Vice President of Health and Wellness Services and Solutions. He noted Walgreens’ ability to deliver basic services, such as drug dispensing, health care clinics, and medical tests, in an affordable, fast, and convenient way, displaying agility that is often difficult to achieve in large health systems. According to Dr. Kang, Walgreens plans to play a larger role in chronic care in the coming years, a further step in moving health care outside of the traditional domains.

Walgreens' partnership
One of Walgreens’ most interesting developments is a partnership with Theranos, a disruptive technology that promises to revolutionize laboratory testing, allowing for hundreds of blood tests with a drop of blood. Equally interesting is that the science behind Theranos has occurred outside the traditional peer-reviewed literature.  In a recent perspective in JAMA, John Ioannidis notes that such “stealth research” creates ambiguity about how to separate possibly brilliant ideas from aggressive corporate announcements. Nevertheless, changes to the health care system are increasingly occurring outside of the traditional spaces.

At the same time, private sector initiatives are shaping the traditional health care system itself. Innovation Health is a joint venture health plan between a leading payer (Aetna) and provider (Inova) in Northern Virginia. The new health plan centers on Inova providers and aligns financial incentives through shared risk and rewards. With Aetna providing the infrastructure for health plan administration, customer services, and online tools, Inova is able to purchase health care cheaper than anyone else on the market (since they’re integrated with the insurer) and offers health plans at lower price points. Aetna can know when each beneficiary is at an Inova center in real time, rather than waiting weeks or months for claims. By reviewing patient censuses each morning, Aetna can send enhanced care coordinators to high-risk patients to engage them at the point-of-care, with the goal of improving outcomes while reducing emergency department and hospital utilization.

Patient-Centered Medical Homes, ACOs and Bundled Payments
Meanwhile, America’s Health Insurance Plans, the national trade association representing the health insurance industry, has been compiling a map of private sector initiatives in payment and delivery reform across the country from patient-centered medical homes and ACOs to bundled and global payments. While these innovations were, in part, spearheaded by policies originating with the Affordable Care Act and continue to be a large part of innovation in Medicare, the private sector is now both adopting and driving these changes to the health care system.

As the American health care system continues to evolve, the private sector is primed to play a major role alongside policymakers, researchers, and providers in shaping the outcome. From innovations outside the traditional research infrastructure and delivery of care outside of emergency rooms and physician offices to changes in the way the health care system delivers and pays for care, advances in the private sector remind us that, despite trends for increased regulation, America’s value of free enterprise is alive and well in health care.