AL Providers, Payer Form Value-Based Medicare Advantage Plan

Huntsville Hospital and University of Alabama Birmingham Health System (UAB) are partnering to create a value-based Medicare Advantage plan through Viva Health.

“We are true partners in our members’ health,” said Tara Bryant, MD, Viva Health’s chief medical officer. 

“As a local health plan, we have forged strong relationships with health systems and providers and work hand in glove with those who are treating our members. Viva Health’s resources include nurses, social workers and pharmacists who offer assistance to providers treating complex and chronically ill patients. We look forward to bringing this kind of team approach to Medicare recipients in Huntsville.”

The state of Alabama has seen a 25 percent decrease in its uninsured population since 2001, according to America’s Health Rankings by UnitedHealth Foundation. In 2001, the uninsurance rate was 12.9 percent. Today, 9.7 percent of Alabamans lack health insurance, placing it 37 among the 50 states.

While uninsurance has decreased, however, health outcomes have gotten worse for seniors in Alabama, according to the UnitedHealth Foundation’s 2019 Senior Report.

The state ranks among the ten states with the worst senior health and has declined two spots since in 2018. This was due to poor behaviors and poor patient outcomes. 

Alabaman seniors are also in the bottom quintile for depression, mental destress, and social isolation risk as well as a high prevalence of physical inactivity.

“We have a crisis in health care in America and Alabama,” said David Spillers, Huntsville Hospital Health System’s chief executive officer. “If we are going to see any improvement in the health of Alabamians, we have to work together and change how we have done things in the past. We look forward to working with UAB Health System in this effort.”

The Medicare Advantage plan will serve seniors in the North Alabama region. The hospitals will focus on value-based care, population health, and rural health.

The Medicare Advantage plan will be offered through VIVA Health, which is among the managed care companies in the state with the highest growth according to its website.

Services at Viva Health’s disposal for the Medicare Advantage plan include home health agencies, skilled nursing facilities, pharmacies, and durable medical equipment providers.

Home healthcare provisions could be critical for seniors in an area that ranks second to lowest in the country for the number of home health care workers per 1,000 adults over the age of 75.

Viva Health’s Medicare Advantage plan is the only Medicare Advantage plan from Alabama to be ranked as one of the best in the nation. It achieved 4.5 out of 5.0 stars for its Medicare quality measures review in 2020.

“Huntsville Hospital and UAB are aligned in their commitment to improve health care in Alabama,” said Will Ferniany, UAB Health System’s chief executive officer. “Working with Huntsville Hospital Health System will help us all achieve this goal in North Alabama.”

In addition to offering the Medicare Advantage plan, the hospitals intend to investigate ways to improve its procedures to advance more efficient and effective care.

The movement of hospitals into the payer space, as Huntington Hospital and UAB intend to do, is a natural progression, according to some experts.

Kurt Wrobel, Geisinger Health Plan’s chief financial officer, explained that it is a missed opportunity for hospitals that choose to forego this step.

“ACOs can form relationships with insurance companies. They can potentially do things with CMS,” he told RevCycleIntelligence.com in 2018. “But here we have the individual in an insurance product from beginning to end, the entire continuum of the delivering and financing of care, and we think there's a significant advantage.”

The goal is to gain greater control over healthcare spending and potentially improve quality. The arrangement allows hospitals to make riskier investments and control care across the continuum more efficiently, he argued.

As Viva Health awaits CMS approval for the Medicare Advantage health plan, Huntsville Hospital Health System is also looking into other Medicare Advantage and prescription drug plans with which to partner.