MORGANTOWN — The West Virginia University Health System (operating as WVU Medicine) and The Health Plan, a Wheeling-based managed care organization announced on Tuesday their intent to come together to form “a fully integrated healthcare delivery and financing system for the people of West Virginia.”

The Health Plan — a nonprofit managed care organization — will become a member and subsidiary of the WVU Health System but will continue to operate as a community-based nonprofit.

The two organizations said in a joint press release that studies have found that establishing a fully integrated network such as this can help the U.S. healthcare system achieve the triple aim of healthcare reform: providing better quality care at a lower cost while focusing on population health.

Albert Wright, president and CEO of the WVU Health System, reiterated in a phone interview what he’s said before: that the only wat to get true healthcare cost control and coordination is when the payor and provider are aligned.

The traditional healthcare model rewards the payor for withholding pay and rewards the provider for treating sick people, he said. This integrated model aligns their goals; they’ll still treat the sick but they’ll also emphasize prevention and wellness.

Looking ahead, he said, the two organizations took about a year and a half to get to this point. But it now sets up a blueprint for other organizations to become a part of or to emulate. A number of hospital CEOs he contacted on Tuesday to give them a heads up about the integration wanted to learn more.

“I think it’s going to be interesting to see where this goes,” Wright said. He noted that their size and scope and West Virginia roots made them a perfect fit, rather than aligning with a big national insurer or MCO.

Wright and Jim Pennington, president and CEO of The Health Plan, explained how the integration will work for various healthcare populations. WVU Medicine will continue to work with other insurers along with The Health Plan. The Health Plan works will continue to work with other healthcare systems where its customers seek care.

Jointly, they will share information and roll out new offerings in 2020 and 2021 – among them Medicare Advantage plans, Medicaid and PEIA coverage. WVU Medicine employees will receive future coverage opportunities. Pennington said a Medicare Advantage plan will be the first offering.

“This new partnership and alignment is a homegrown way to care for West Virginians more effectively and efficiently,” Wright said in the release. “By aligning and integrating our two organizations and by leveraging our respective expertise in a more coordinated fashion, we can deliver better outcomes to the people of West Virginia. The Health Plan will also continue to build collaborative, value-based partnerships with other health systems and independent providers in West Virginia.”

Pennington said, “This is the marriage of two great West Virginia brands that want to come together with the shared vision and goal of creating a healthier West Virginia.”

The Health Plan, the release said, will become a member of WVU Health in a manner similar to how several hospitals have recently joined WVU Medicine. The Health Plan will remain a non-profit corporation with a separate board, but will have access to the many shared resources of WVU Medicine.

For WVU Medicine patients not insured by The Health Plan, they said, “WVU Medicine will seek to maintain positive relationships with all of its payer partners, but it is possible that one or more payers will react negatively to the integration and seek to discontinue or modify the terms of its participation agreements with WVU Medicine.”

For those insured by The Health Plan who don’t use WVU Medicine, they said beneficiaries will not face any disruption to their care. “In the immediate term, members are unlikely to see any difference. In the medium term, we expect the Integration to result in better resources for members related to care coordination, wellness, and social work. We also expect the integration to increase access to care through enhanced telemedicine and other forward-thinking health services.”

The Health Plan will continue to offer a managed PEIA plan option for West Virginia state employees, they said. WVU Medicine will continue accepting both managed and non-managed PEIA plans, and will continue participating in PEIA’s Comprehensive Care Partnership program.

WVU Medicine will continue participating with a number of other Medicaid, Medicare Advantage, and Commercial plans, they said. For example, in addition to original Medicare, WVU Medicine will continue participating in Humana and United Medicare Advantage products.

The specific terms of the partnership are subject to the approval of the boards of both organizations, pending due diligence processes by both.

The Health Plan, Pennington added, will also be one of the MCOs to bid on managing the state’s foster care program under the Department of Health and Human Resources, and the only West Virginia-based company to bid.

Tweet David Beard @dbeardtdp Email dbeard@dominionpost.com

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