WellStar, Piedmont Healthcare Partnering on Health Plan

Press release:

Piedmont Healthcare and WellStar Health System have announced a partnership to develop a new health-system-based health insurance plan. The initial goals for the health plan include offering Medicare Advantage, commercial and self-funded products to the general public that will launch in 2014, as well as making the plan available to the two health systems’ combined employee and family base of more than 35,000.

This partnership comes on the heels of last month’s announcement that the health systems had formed the Georgia Health Collaborative, a first of its kind in the state, focused on the development of innovative healthcare delivery models such as population management.

Piedmont began development of a health-system-based health insurance plan in late July 2012 when it partnered with Evolent Health, a Washington, D.C. company created by the Advisory Board and the Pittsburgh-based UPMC, to create and launch the health plan. UPMC, through Evolent, will be helping other systems across the country develop health-system-based health plans.

”We believe our industry’s future relies on successfully implementing a population health model of care—delivering disease prevention and care management with higher quality at lower costs,” Gregory A. Hurst, president and interim chief operating officer at Piedmont, said in a news release Monday. “Launching a health plan helps us move more quickly toward that future, and we consider this yet another area where we can demonstrate vision and leadership in Georgia’s healthcare industry.”

“As leaders in the Atlanta healthcare market, Piedmont and WellStar are uniquely positioned to work together to achieve improved clinical results and reduction in costs as dictated in the 2010 federal Patient Protection and Affordable Care Act,” Reynold J. Jennings, president and CEO of WellStar, said in the release. “Health systems that have a broader geographic reach and larger population base will be best suited to react to and sustain operations regardless of future federal and state legislative outcomes.”

Both Piedmont and WellStar have been successful at creating Accountable Care Organizations (ACOs), including patient medical homes, which address the disease prevention and management aspect of a population health model. Success of such programs hinge on the support and coaching health systems provide to patients, particularly those with chronic illnesses.

WellStar began its journey with population health management starting in July 2012, when the Centers for Medicare and Medicaid Services awarded WellStar with the ACO designation, assigning over 35,000 Medicare beneficiaries to the WellStar ACO. Piedmont began its work in population management in 2010 when it partnered with Cigna on an ACO pilot that has expanded and continues today.

Piedmont Healthcare’s Ronnie Brownsworth, M.D., CEO of the newly formed health plan, has expertise in population health models as well as experience negotiating with managed care companies. A practicing neurologist for 12 years, Brownsworth earned his MBA with an emphasis on healthcare while gaining experience in physician practice administration and integration. He soon found himself on the hospital side as chief medical officer and vice president of quality as well as developing and running a highly successful health-system-based health plan for Saint John’s Health System in Springfield, Mo.

“This health plan will keep patients and physicians at the center of our care model with the ultimate goal of improved health in our patient populations,” Brownsworth said. “We also look forward to continuing our work with other insurance plans in finding ways to deliver the best results for our patients.”

“Health-system-sponsored health plans and their participating physicians, have the unique ability to provide high quality ‘patient centered’ care, that results in a healthier population, which will allow us to bring healthcare inflation more in-line with general inflation,” said Jim Budzinski, president of the WellStar Health Network ACO and WellStar’s executive vice president & chief financial officer, who previously worked closely with Brownsworth.