Muscling in on IT

In­sur­ers see ac­qui­si­tions as key to data-shar­ing

Modern Healthcare - - COVER STORY - Jaimy Lee

Health in­sur­ers are mov­ing into the tech­nol­ogy busi­ness of ac­count­able care. Three Blue Cross and Blue Shield health plans and the health in­for­ma­tion tech­nol­ogy com­pany Lumeris Corp. an­nounced plans last week to ac­quire Navinet, a na­tional com­mu­ni­ca­tions net­work that con­nects physi­cians and other providers to health plans, for an undis­closed sum.

Unit­edhealth’s health ser­vices di­vi­sion, Op­tum, an­nounced last week its own in­vest­ment in ac­count­able care tech­nol­ogy. Op­tum said it had launched a “cloud” sys­tem al­low­ing care­givers to con­nect with pa­tients’ other providers—ca­pa­bil­i­ties that Op­tum pro­moted as “nec­es­sary for full par­tic­i­pa­tion in ac­count­able care or­ga­ni­za­tions and other emerg­ing care mod­els.”

Highmark in Penn­syl­va­nia and West Virginia, Hori­zon Blue Cross and Blue Shield of New Jer­sey, In­de­pen­dence Blue Cross in south­east Penn­syl­va­nia and Lumeris said the ac­qui­si­tion of Navinet will in­crease col­lab­o­ra­tion with physi­cians, hos­pi­tals and in­sur­ers. They also said the com­bi­na­tion of the Navinet and Lumeris tech­nolo­gies is ex­pected to “ease the adop­tion of new ac­count­able care mod­els through the coun­try.”

Dou­glas Black­well, Hori­zon’s se­nior vice pres­i­dent and chief in­for­ma­tion of­fi­cer, said the deal fits into the Hori­zon busi­ness model, which calls for moves into ac­count­able care and dif­fer­ent pay­ment method­olo­gies.

About a year and a half ago, Hori­zon launched a “health­care in­no­va­tions” sub­sidiary with a goal to “de­velop in­no­va­tive col­lab­o­ra­tive mod­els for the de­liv­ery and fi­nanc­ing of high qual­ity care in New Jer­sey,” the Ne­wark-based com­pany said in a news re­lease at the time.

“We see this as an­other op­por­tu­nity to have an in­te­grated plat­form,” Black­well said. “When you look at the ge­og­ra­phy of Highmark, Hori­zon and IBC, we’re ge­o­graph­i­cally aligned and it’s go­ing to make sense to do things col­lab­o­ra­tively go­ing for­ward.”

There are about 70,000 providers within the

Highmark, Hori­zon and In­de­pen­dence ser­vice ar­eas. How­ever, the com­pa­nies said the Lumeris ac­count­able care de­liv­ery plat­form will be made avail­able to the Navinet net­work, which the com­pany says has en­rolled about 75% of the physi­cians in the U.S.

All three in­sur­ers pre­vi­ously in­vested in Bos­ton-based Navinet, Black­well said, and the health plans’ cor­po­rate ven­ture fund was one of sev­eral firms to in­vest last year in Essence Group Hold­ings Corp., the par­ent com­pany for Lumeris. Blue Cross and Blue Shield Ven­ture Part­ners, Kleiner Perkins Cau­field & By­ers and Cam­den Part­ners in­vested $70 mil­lion in the Essence Group in Oc­to­ber. Lumeris said at that time that the ma­jor­ity of the in­vest­ment was di­rected to­ward Lumeris and its ac­count­able care de­liv­ery plat­form.

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