MaineHealth's ACO president talks new Medicare Advantage plan with Anthem

In late August, Portland-based MaineHealth announced plans to create a joint venture with Anthem Blue Cross and Blue Shield of Maine.

Through the joint venture, called AMH Health, MaineHealth and Anthem plan to sell Medicare Advantage policies for 2020. 

Here, Betsy Johnson, MD, president of the MaineHealth ACO and an executive sponsor of the MaineHealth-Anthem joint venture, answered three questions for Becker's Hospital Review about AMH Health and the provider's Medicare Advantage strategy.

Editor's note: Responses have been lightly edited for clarity and length.

Question: What was MaineHealth's strategy behind partnering with a payer for a health plan?

Dr. Betsy Johnson: With the joint venture between MaineHealth and Anthem Blue Cross and Blue Shield, we saw an opportunity to bring together the core strengths of the region's leading healthcare system and health insurance provider. Our goal is to create a Medicare Advantage option that will support healthy aging for Maine seniors with a comprehensive, whole-person approach to care.

Q: Why did MaineHealth chose the Medicare Advantage market?

BJ: Development of a strong Medicare Advantage strategy became a priority for MaineHealth and MaineHealth ACO (MHACO) given Maine's significantly aging population and a desire to provide a Medicare plan that provides high-quality product offerings at a great value for seniors. Medicare Advantage allows for customizable benefit design that can strongly support provider-patient relationships, manage expenses, and offer unique care management and risk management support. We know that MA has rising popularity among baby boomers, and we wanted to design and offer in collaboration with a payer partner the best new MA product for Maine seniors.

Nir Harish, MD, an emergency medicine physician at Pen Bay Medical Center in Rockport, Maine, and a member of the provider council working on this project, put it well. He said: "This partnership can open up entire worlds of possibilities for us. As an integrated payer-provider, we can redesign how we organize and pay for care in a way that makes the most sense for us and our patients."

Q: What makes a joint venture different than a typical relationship between a payer and provider? 

BJ: Obviously, the fact that we are in a joint venture together sets this effort apart from the typical payer-provider relationship. 

Frankly, we are leveraging the strengths of both organizations in a new unique partnership, and we are committed to a long-term relationship creating stability and innovation for Maine's seniors. We believe a unique feature that distinguishes our JV is the creation of a Provider Advisory Council that provides a forum where providers can have input and use their depth of experience to collaborate with Anthem on the development of population health strategies, provider engagement, alignment, collaboration and transparency.

Together we have focused on building a partnership that has required a lot of due diligence and work with state and federal regulators. Thus far, our organizations have worked really well together, and we are looking forward to creating a product that will be of great benefit to our patients and becomes the MA market leader in Maine. 

More articles on payers:
Aetna ushers in new Kansas leadership with Medicaid contract in jeopardy
What 5 physician execs have to say to other MDs seeking payer leadership roles
This Medicare Advantage insurer is nearing $1B in revenue — CEO John Kao explains how

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