Vivity, as analysts have pointed out, is similar in structure to the HMOs that swept through the health insurance marketplace in the 1990s. Back to the future, indeed.
This time, however, the providers are not only willing participants but have a financial stake in the success of the joint venture. If Vivity can attract a critical mass of consumers, it should incentivize its provider partners to collaborate in care coordination and to begin moving the needle on eliminating unnecessary procedures.
There are technical issues to overcome. High on the list is the lack of interoperability between the partners' various electronic health-record systems. It spoke volumes about the state-of-play in the health IT industry when Vivity's partners announced they would initially rely on Anthem's claims records to coordinate care.
There could also be antitrust concerns, although that's probably not an issue in a large, sprawling market like L.A. and for partners assuming financial risk. When just two or three competing networks emerge in a midsized market, regulators may well see the potential for price-fixing that benefits both the insurers and providers in ostensibly competing networks.
And there's still the issue of establishing trustworthy benchmarks for consumers to evaluate the quality, safety and outcomes of competing systems. Those are the measures that matter most to many consumers.
The networks emerging across the country still don't offer reliable and easily interpreted data that will allow potential customers to evaluate the competition. Price isn't everything, and the absence of transparent quality data will slow the emergence of the HMO-ACO hybrid model unveiled last week in L.A.
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