As part of our ongoing coverage of health transformation, we occasionally share conversations with market innovators. Here, Maureen O’Connor, president of Durham, NC-based Mosaic Health Solutions, explains how Mosaic is helping to advance value-based healthcare (VBH). She also provides her assessment of overall progress on the way to value-based care:
Oliver Wyman Health: What is the mission of Mosaic Health Solutions?
Maureen O'Connor: Mosaic is the strategic investment arm of Blue Cross Blue Shield of North Carolina. Alongside our investment partners and healthcare system stakeholders, we are deploying financial and intellectual capital into innovative healthcare companies that are accelerating the transformation of the healthcare system. Financial returns are paramount, but we want to achieve those returns while making our healthcare system better.
OWH: How is Mosaic helping to advance our health system to VBH?
MO: Mosaic is investing in companies that have the potential to positively impact all stakeholders in the healthcare ecosystem – companies focused on simplifying the experience for consumers and providers, making healthcare more convenient and affordable, and producing better, measurable outcomes. In particular, we have made multiple investments in companies with alternative, or newer, approaches to delivering care.
OWH: Is there a particular “win” on the way to VBH that stands out?
MO: Two come to mind. The first is FastMed Urgent Care. FastMed operates 105 urgent care centers in North Carolina, Arizona, and Texas. FastMed offers consumers convenient healthcare right in their own neighborhoods; and, by building a model that has now been replicated in three states, a familiar patient experience associated with a trusted brand. Quality urgent care in convenient locations is a win for busy consumers, but it also minimizes costly emergency room visits, which is a welcome alternative for payers and employers as well.
The other is Community Medical Group (CMG), a leading operator of primary care medical centers in South Florida. CMG serves Medicare, Medicaid, and Affordable Care Act members through risk-based managed care contracts. It provides comprehensive care in exchange for a flat, contracted reimbursement rate from payers. CMG employs a proactive approach to the delivery of healthcare, aiming to provide clinical care as well as address many of the basic life needs for its patient population. By providing transportation to appointments, prescription delivery, and strategically locating its clinics adjacent to state-run social services centers, CMG is removing barriers that may prevent patients from receiving care or for caring for themselves. As a result, CMG is producing positive outcomes at lower cost. They have very high patient satisfaction and their model is extremely attractive to physicians and physician extenders looking to care for their patients in a highly personalized manner.
Platform solutions that can drive value across multiple dimensions will be the winners, while point solutions will continue to struggle to gain scale and market traction.
OWH: Where are you seeing faster progress on the way to VBH than you might have expected? Slower?
MO: We are seeing a flurry of activity in the area of consumer engagement. There seems to be little debate among stakeholders in the healthcare system that we need to move quickly to understand the needs of the consumer and how we can more effectively engage consumers in their own health. There are a number of interesting companies focused on analytics, consumer segmentation, incentives, and digital health monitoring that have entered the market at a fast pace. That’s the good news. The bad news is that many of these are technology point solutions and the integration and adoption of these technologies by health systems and health plans has not kept pace. The sales cycle for health systems and health plans is typically months – not weeks. Platform solutions that can drive value across multiple dimensions will be the winners, while point solutions will continue to struggle to gain scale and market traction.
OWH: What do you think is the next phase of VBH evolution? What can we expect to see over the next 12 months?
MO: We are beginning to see true partnerships between unlikely bedfellows, with aligned incentives aimed at enhancing value for the system – not just for one stakeholder in the system. Over the next 12 months, I think we will see more integrated delivery and payment models entering the market – perhaps under a dual or “white-labeled” brand – aimed at providing consumers with a seamless and more convenient way of accessing care and benefits in their local communities. As those partnerships emerge, they will become the logical platform for further innovation and collaboration in the consumer engagement space.
The horse is out of the barn in the move to VBH. While the November elections could impact certain regulatory and structural issues in healthcare, the elections are unlikely to cause a retreat away from VBH. Consumers are now demanding the same value in healthcare that they have come to expect in other aspects of their lives and there’s no turning back.