Some health insurers have offered physicians and hospitals in their networks a temporary source of population-based payments to ensure they keep their doors open during the COVID-19 crisis. But some groups are calling for more permanent measures.

Inland Empire Health Plan, based in Rancho Cucamonga, Calif., said it would fill gaps in hospitals’ revenue and bolster specialists’ payments for three months. Similarly, Buffalo, N.Y.-based Independent Health stepped up value-based payments by giving primary-care practices an emergency global payment to help them maintain a monthly cash flow resembling pre-pandemic levels.

“We’re really just trying to support our network, because we want to keep (providers) moving forward through this so that when this is stabilized, our network is intact,” said Susie White, Inland Empire’s chief operating officer.

If specialists were to close their offices or hospitals to cut services, patients would have less access to healthcare, she said.

For April, May and June, Inland Empire promised to pay hospitals at least as much as their monthly average revenue in 2019, filling any gaps in revenue as if the hospitals were capitated. It also bolstered specialists’ payments using a different formula.

The insurer, which serves 1.2 million mostly Medicaid members in Southern California, already pays its primary-care physicians and independent physician associations on a capitated basis, meaning physicians receive a set monthly payment to take care of each patient. Primary-care practices have continued to receive the same amount of funds during the pandemic as they did prior to it and are in a “good space” financially, White said.

Independent Health normally pays primary-care practices one upfront per-member, per-month payment to provide services not typically covered in the fee-for-service reimbursement world. That “global” payment is in addition to fees for services that Independent Health wants to encourage, such as preventive-care appointments and follow-up visits after a hospitalization.

When doctors’ fee-for-service revenue plummeted, Independent switched to an all-encompassing global payment to prop up cash flow for March, April, May and June.

Independent Health CEO Michael Cropp said the insurer is mulling how it could continue offering one population-based payment even after the COVID-19 crisis. He is concerned, though, that if other insurers continue to pay fee-for-service, providers would have an incentive to prioritize those payers’ members over Independent Health’s.

Inland Empire said it has no plans to continue paying hospitals on a capitated basis beyond this month.


Source: Insurers create temporary population-based payment models