CHESS Coordinates Value-based Collaboration Between Wake Forest Baptist Health and UnitedHealthcare Around Medicare Advantage Offering

April 11, 2016

UnitedHealthcare and Wake Forest Baptist Medical Center, in partnership with CHESS, have launched an accountable care program to improve people’s health and their satisfaction with their health care experience.

The joint effort will focus largely on dedicating more resources to care coordination, making it easier to share important health information so that every doctor and team member involved in a patient’s care is supporting the same treatment plan.

UnitedHealthcare and Wake Forest Baptist’s accountable care program changes the incentives for how people’s medical care is paid for in North Carolina, moving away from a system that reimburses for quantity of services provided to one that rewards the quality of patients’ health outcomes and has the potential to reduce overall costs.

All North Carolina residents enrolled in UnitedHealthcare’s Medicare Advantage plans are eligible to benefit from this collaboration. More than 25,000 UnitedHealthcare Medicare Advantage members access Wake Forest Baptist’s services each year.

“Wake Forest Baptist has long partnered with UnitedHealthcare, providing our expertise in health care innovation and patient-centered programs to improve the health of their plan participants and advance population health management,” said Richard Lord, M.D., professor and vice president, Population Health at Wake Forest Baptist. “Together, we expect to improve health outcomes, the relationship with the care team, and patient satisfaction, while reducing the overall cost of care.”

Many people who have gone to the doctor or hospital – particularly those with complex or chronic illnesses – have found they often have to connect information from each of their doctor visits themselves, and have sometimes received duplicative tests or care that isn’t coordinated.

UnitedHealthcare, through CHESS, will supplement Wake Forest Baptist’s own data to help support overall population health, giving the entire care team clear, actionable data about individual patients’ health needs and potential gaps in care as well as identifying high-risk patients. Patient navigators will support community-based care coordination, such as helping with planning after a patient is discharged from the hospital and scheduling follow-up appointments.

Adds Charles Vignos, vice president of Managed Care at Wake Forest Baptist, "The innovative relationship that CHESS has brought forward with United Healthcare Medicare on our behalf will allow us to be proactive in the management of our respective United Healthcare Medicare patient. This will permit more effective management of patients' chronic conditions such as diabetes, hypertension, and obesity. This enhanced management will provide a better quality outcome for these patients."

More than 14 million people enrolled in UnitedHealthcare plans across the country have access to accountable care programs, delivered in part through more than 750 accountable care arrangements nationwide as the organization engages in deeper, more collaborative relationships with physicians and hospitals.

Care providers nationwide are showing strong interest in a shift to value-based care. UnitedHealthcare’s total payments to physicians and hospitals that are tied to value-based arrangements have tripled in the last three years to $45 billion. By the end of 2018, UnitedHealthcare expects that figure to reach $65 billion.