CVS, Catholic Health strike deal to provide Medicare patients with medical care, cab rides and meals

Catholic Health and CVS Health have struck a deal to provide nearly 40,000 Long Island-area Medicare recipients with primary, specialty, walk-in and home-based care as well as help with transportation, food and housing for those in need.

The agreement between Rockville Centre-based Catholic Health and CVS Accountable Care Organization, Inc., a division of Rhode Island-based CVS Health, involves an increasingly common way of paying for health care, called “value-based care.” It gives providers financial incentives for improving quality and reducing costs, rather than simply paying for each service. Catholic Health and CVS announced the plan in a statement to be released Wednesday. 

Under the arrangement, the federal Medicare program pays CVS Accountable Care on a monthly basis for treating patients, with the payments based on the expected cost to treat those patients' conditions, CVS said. In turn, CVS provides incentives to Catholic Health for meeting quality and cost-savings goals such as providing preventive care and avoiding unnecessary emergency room visits and hospital stays.

“We want to find the disease before the disease finds them,” said Joseph Lamantia, executive vice president and chief transformation officer at Catholic Health. “We hope to keep them out of the hospital when they don't need to be there; we hope to improve their overall satisfaction.”

Catholic Health and CVS said the program helps improve coordination between primary care doctors and specialists treating those with chronic conditions. In addition, Medicare patients in the program who need after-hours or weekend care can be referred to CVS MinuteClinics, which are staffed by nurse practitioners and physician assistants, Lamantia said.

Roughly 600 Catholic Health doctors are taking part in the CVS partnership, which began earlier this year, Lamantia said. There are no changes in the way participating providers bill patients, and all patients get notified about doctors' participation in the program, according to Catholic Health and CVS. 

The CVS division is one of 132 Accountable Care Organizations, or ACOs, taking part in a new Medicare program called ACO Realizing Equity, Access, and Community Health, according to the federal agency that runs Medicare, which provides health coverage to about 65 million Americans.

Under more traditional “fee for service” systems that pay health care workers based on the treatments they provide, patients “are falling through the cracks,” said Dr. Mohamed Diab, CEO of CVS Accountable Care Organization.

But in value-based care, quality and cost-savings bonuses provide financial incentives for  health care workers to contact patients to schedule preventive care, screen them for health problems and find out if they have access to transportation, nutritious food and safe housing, he said. If needed, providers connect patients with community groups and transportation providers.

The company analyzes census data to determine which patients are likely to be especially in need of help, Diab said. CVS said it employs more than 40,000 doctors, pharmacists, nurses and nurse practitioners nationwide.

Many value-based care programs have been shown to improve care, said Theresa Dreyer, the Association of American Medical Colleges’ manager of value-based care and co-author of a paper on the subject.

“It's not a silver bullet, but there is a strong body of evidence to show that even for the [value-based programs]  that didn't save money, quality has either stayed the same or improved,” in part by providing medical treatments and other services that help patients avoid emergencies, Dreyer said.  “The cost of that emergency might be in the tens of thousands [of dollars], and the cost of the cab ride and the meals is under 50 bucks.”

By Maura McDermott

maura.mcdermott@newsday.commauramcdermott

Maura McDermott is a reporter on the investigations desk. Since starting at Newsday in 2012, she has also covered real estate and the business of health care.