Evolent Health and SOMOS IPA Aim to Provide Physician-Driven Medicaid Managed Care through New York Innovator Program
WASHINGTON and NEW YORK, /PRNewswire/ -- Evolent Health, Inc. (NYSE: EVH), a company providing an integrated value-based care platform to the nation's leading health systems and physician organizations, and SOMOS IPA today announced that Evolent will support the SOMOS IPA network in its operations as a Value-Based Payment (VBP) Innovator in the New York State Department of Health's Innovator program. As announced by the New York State Department of Health, SOMOS IPA has received a new contracting designation as a Value-Based Payment Innovator. The Innovator program is intended to encourage and reward early adoption of Value-Based Payment arrangements, supporting groups who have invested in moving toward population health management. With its Innovator designation, SOMOS aims to transform the communities it serves by reintroducing the family doctor and strengthening the bond between doctor and patient.
SOMOS IPA is the only physician group with Innovator designation to date, mirroring its status as the only physician-led, community-based participant in the New York State Department of Health's Delivery System Reform Incentive Payment (DSRIP) program, which was established to help improve outcomes and reduce avoidable hospital use by 25 percent. Through the Innovator program, SOMOS and Evolent aim to serve Medicaid beneficiaries in New York City through a doctors-first, culturally-sensitive care model with a particular emphasis on social determinants of health. In collaboration with SOMOS providers, Evolent will deploy clinical programs to proactively address health issues to improve outcomes and avoid unnecessary hospital use. Evolent is also providing SOMOS with its population health performance management platform, IdentifiSM, to share critical analytics across network providers, facilitate efficient care coordination, launch and operate a suite of clinical programs and integrate clinical and other data across the network.
SOMOS IPA is focused on strengthening connections between doctors and patients in some of the highest need and most diverse communities in New York. Founded by Dr. Ramon Tallaj, an immigrant himself and longtime leader in the Latino community, SOMOS IPA is comprised of three community-based Physician IPAs—Corinthian, Excelsior and Eastern Chinese American Physicians—as well as a range of other community-based organizations.
"Our priority is to create the best connection possible between people and providers. The State's investment in our work gives every doctor in the SOMOS network the tools to address persistent health disparities in diverse, vulnerable communities—and it's only through our network's partnership with Evolent that we can meet this challenge and save lives," said SOMOS IPA Founder and Board Chairman Dr. Ramon Tallaj. "Traditionally, large health organizations have been the only ones with the infrastructure to take on fully-capitated risk. The State's recognition of our ability to accept full risk, including health plan functions, is ground-breaking. We look forward to leveraging the strength of our network and Evolent's capabilities to spearhead a physician-led care model and continue to build a sustainable, transformative connection with patients."
According to the New York State Department of Health, New York's Value-Based Roadmap is unique in requiring Innovators to include community-based organizations and address social determinants of health interventions such as housing, food insecurity or transportation. SOMOS and Evolent will work together to connect patients to local community resources to support patients outside of the doctor's office.
Value-Based Payment Innovators can contract at the most advanced payment levels with Managed Care Organizations (MCOs) to improve quality of care for a defined group of patients while sharing in financial gains and risks. As a participant in the Innovator program, SOMOS IPA is now able to pursue delegated risk arrangements with MCOs in which it would take on additional management and administrative functions, such as utilization and claims management. SOMOS IPA would then be eligible for an increased portion of the monthly payment made by Medicaid for the lives it manages in the program. Over the coming months, SOMOS intends to contract with MCOs to take on delegated risk and begin care coordination for Medicaid lives in mid to late 2019.
"We are honored to work with SOMOS to put primary care at the forefront of the value-based care delivery system to address the unique challenges of its Medicaid population," said Evolent Health President Seth Blackley. "When Evolent and SOMOS considered the opportunity presented by the Innovator program, we were aligned in our mission to bring our capabilities together to empower physicians to manage fully-capitated risk—a model we are confident will help shape the future of health care in New York. Evolent is proud to bring the full set of financial, administrative and technology capabilities SOMOS will need to succeed at managing full risk for its New York City communities."
"We applaud SOMOS IPA for achieving Value-Based Payment Innovator status and continuing to move the needle on value-based care in New York," said Evolent Health Chief Executive Officer Frank Williams. "With deep ties to its New York City communities and a reputation as a leading provider network, SOMOS is well-positioned to be a national model for culturally-sensitive preventive and primary care, and for structuring a community-connecting care organization to be financially stable under Medicaid."
As announced in May 2018, Evolent and SOMOS IPA originally partnered to support the performance goals of New York's DSRIP program. For more information, please refer to Evolent's press release.
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