Impactful Payer-Primary Care Alliances

Establishing deep payer-primary care alliances supported by an integrated value-based care (VBC) approach is one of the key strategic pathways to improving the quality of care, increasing member/patient satisfaction levels and lowering healthcare costs. Major insurance companies are establishing alliances in their markets through acquisitions, joint ventures and strategic contracts. Furthermore, hospital systems are acquiring primary care practices to improve care delivery networks and support accountable healthcare organizations and health plans.

Lucerna Health has several years of experience establishing and supporting payer-primary care alliances in the Florida, New Jersey and Connecticut markets with Sanitas USA, Lucerna Health’s strategic clinical partner, and leading health plans. These alliances, when properly designed and operated, provide a strong foundation for substantially improving results for members/patients, payers and providers.

Although each alliance is customized to meet the needs of the local market, there appear to be several common critical success factors including:

  • A common vision and mindset—establish a collaborative, transparent, win-win relationship to drive meaningful change creating increased value through advanced primary/urgent care medical centers
  • Deep integration and coordination—across key processes including analytics, product/network design, care/service programs and go-to-market initiatives
  • Long-term financial alignment—beyond a typical payer-provider network contract ensuring success for the member/patient, the provider organization and the health plan
  • Aggressive growth plan—supporting patient volume in the new medical centers in key geographic markets, including underserved communities across multiple insurance market segments

In Florida, the alliance has supported the health plans objectives in the hyper-competitive South Florida market. “After visiting with Sanitas in Colombia several years ago when I was the Chief Strategy Officer at Florida Blue, I was confident that they could support our core strategies in many ways,” said Craig Thomas, CEO of Lucerna Health. “The resulting joint venture with Sanitas has exceeded my expectations on several fronts including membership growth, relevance in the Hispanic market and the quality and cost of healthcare for members.”

In New Jersey, the alliance has supported initiatives to serve the health plans membership in underserved areas. “Our strategic initiative with Sanitas is helping us achieve our triple-aim goals of improving quality outcomes, reducing costs and delivering a better patient experience while increasing access to quality care for underserved communities and better integrating primary care with New Jersey’s hospital systems,” said Dr. Thomas Graf, Horizon Blue Cross Blue Shield of New Jersey Vice President and Chief Medical Officer. “We are excited to see the relationship continue to advance as we expand into additional markets.”

Sanitas USA believes that creating value through exclusive payer partnerships is an effective way to bring their clinical model to market across the United States. “We believe in creating value through patient-centered advanced primary care medical centers in partnership with forward-looking health plans,” said Dr. Fernando Fonseca, Sanitas USA Chief Executive Officer. “Lucerna Health is helping us navigate the market and establish successful initiatives with payers as we pursue our aggressive expansion plans in the United States market.”