MSSC affiliate WPPA ProviDRs Care is launching a new value-based insurance product, NexUS, on July 1 that is designed to appeal to both physicians and employers.
“NexUS will apply a commonsense approach to the delivery of health care. By encouraging activities shown to create value, we will create an excellent product at a favorable cost,” said WPPA board member Dr. Joe Davison.
“NexUS is primary-care-centric,” said Justin Leitzen, director of network innovations, and has been designed with valuable input from MSSC members, with Drs. Davison, John Lohnes and Dennis Knight leading the effort.
NexUS will allow both employed and independent physicians to participate in a value-based delivery model. It aims to lower health care costs by aligning provider and employer incentives, said Karen Cox, CEO of ProviDRs Care.
“Medicine works best when the physician and the patient work together. NexUS offers a methodology to encourage those relationships and in doing so also brings a benefit for employers,” Dr. Lohnes said.
NexUS is one of several products offered by ProviDRs Care, the only physician-owned PPO in Kansas and one of the few in the country. “Employers have been asking for something like this for years,” Cox said. “It is the direction the industry is going.”
NexUS is not intended to replace fee-for-service, but in addition offers financial incentives in five broader areas – or domains – and providers will be rewarded for their performance.
“Physicians are often worried about accepting downside risk in their practice,” Dr. Davison said. “NexUS will continue to reimburse with their usual fee schedule, but those efficient physicians will receive additional incentives on a per member per month basis.”
The five incentive focus areas are access, utilization, referrals, quality and place of service. A quick way to think of it is making sure members receive the right care at the right time in the right place.
“We are also going to be helping the primary care providers manage their higher-risk patients by providing nurse navigators hired by the network,” Leitzen said. Higher-risk patients are often the major cost drivers in a health care plan.
“By using a carrot instead of a stick approach, we believe significant savings for the health care system can be achieved,” Dr. Davison said. “This very special endeavor by the physicians of Sedgwick County just might be a game changer for our medical practices, patients, and the economic viability of our city’s employers.”
ProviDRs Care has sent letters about NexUS to practice managers and will soon begin contracting with primary care physicians. It will also soon reach out to insurance brokers, consultants and employers to participate in NexUS, which would replace their current health plan.
A strength of NexUS is that KHIN, the Kansas Health Information Network, will provide the clinical data. Because of that robust connection, taking part in NexUS will not burden physicians with additional reporting requirements. Doctors will regularly receive reports including clinical and claims data that will provide a 360-degree view of their patients.
“The intent is to improve care and decrease costs while increasing doctor satisfaction,” Cox said. “Physicians will be able to focus on what they really want to do: helping patients stay healthy.