Forward Health Group Inks Deal with Dialysis Clinic Chain
[Corrected 7/10/17 5:02 p.m. See below.] Fresenius Medical Care North America, an organization that provides healthcare for patients with kidney failure and other chronic conditions, recently signed a multiyear agreement to license software developed by Madison, WI-based Forward Health Group.
Michael Barbouche, founder and CEO of Forward Health Group, says his company will begin installing its population health management software at physician practices operated by Fresenius later this year. Many of the physicians who care for patients at Fresenius-owned dialysis clinics are employed by outside hospitals or medical groups, Barbouche notes. [A previous version of this paragraph incorrectly stated that Forward Health Group’s software will be installed at dialysis clinics operated by Fresenius. We regret the error.]
Acumen Physician Solutions, a subsidiary of Fresenius Medical Care North America, will work with Forward Health Group to integrate the company’s software with Acumen’s electronic health records system, says Katherine Dobbs, vice president of corporate communications at Fresenius Medical Care North America.
Forward Health Group, launched in 2009, develops digital tools designed to allow users to pool patient data from different sources, such as claims sent to insurers, clinical documentation, and labs. With all of this information in place, users of Forward Health Group’s software can group patients into specific populations based on their symptoms, diagnoses, and other attributes. Doing so could allow the company’s customers—which include networks of hospitals and clinics, as well as research groups like the American Heart Association—to identify patients most at risk of congestive heart failure, for instance, and attempt to stop them on their progression to chronic disease.
Fresenius Medical Care North America, headquartered in Waltham, MA, is part of Germany-based Fresenius Medical Care (NYSE: FMS). The company operates more than 2,200 dialysis clinics in the U.S. Its other facilities include outpatient cardiac and vascular labs, and urgent care centers.
Dobbs says she expects Fresenius’s physician affiliates will be the primary users of Forward Health Group’s software. That sets Fresenius apart from other Forward Health Group clients, where the company’s tools tend to be used more often by other types of employees—nurses, medical assistants, and schedulers, for example—than by doctors, Barbouche says. [Updated with information on the types of healthcare workers that use Forward Health Group’s software most frequently.]
Under the terms of the agreement, Fresenius will pay Forward Health Group to license the company’s software on a per-physician basis. Barbouche says one reason for this pricing structure is that under some of its programs, the Centers for Medicare and Medicaid Services (CMS) reimburse for care based in part on the number of physicians at a given practice.
One such program, which the CMS created under a 2015 law that aims to more closely link Medicare payments to quality of care, is the Quality Payment Program (QPP). It’s a quality-based reimbursement program requiring clinicians and healthcare organizations to report select patient data to the agency, via one of two paths. With the help of Forward Health Group’s software, Fresenius-affiliated clinicians expect to report patient data to CMS using the Merit-Based Incentive Payment System path, says Jason Niosi, director of marketing operations at Forward Health Group. (Members of the Acumen Physician Solutions team will help Fresenius’s physician affiliates report quality data to the CMS, Dobbs says.) Once the agency has the data, it assigns a score to the reporting party, which could result in it receiving a Medicare payment bonus, or a penalty, in 2019.
The introduction of the QPP, which first went into effect on Jan. 1, highlights the ongoing shift to quality-based reimbursement models in healthcare. The legacy fee-for-service structure, where healthcare providers are reimbursed for individual units of care such as lab tests, is giving way to what is known as value-based care, where providers are incentivized to keep costs as low as possible by keeping patients healthy.
The American Medical Association and KPMG recently conducted a survey that examined physicians’ knowledge of—and readiness for—the QPP and related programs. According to the survey, 70 percent of respondents have started preparing to meet the requirements of the QPP this year. However, only 23 percent of those who have begun preparing feel well prepared to meet the program’s requirements in 2017.
Barbouche says that despite the work Forward Health Group is doing to help its customers adapt to changes in how the government reimburses organizations that care for Medicare patients, he believes medical practices as a whole are currently not ready to navigate the shifting landscape.
Still, he believes that the CMS’s move toward value-based care could send an important signal to other leading health insurers.
“We think that what QPP represents is the start of a transformation,” Barbouche says. Medicare is “aggressively courting the Aetnas (NYSE: AET), Cignas (NYSE: CI), and others to match the same type of incentive programs. All of these programs are going to carry this idea of performance-based reimbursement. They’re not going to be focused on legacy fee-for-service.”