Optum’s SCA Health now operates more than 370 ASCs and surgical hospitals across 38 states, with more than 60 health system partners and thousands of total joint replacements performed every month.
That scale is exactly what’s letting the company build its own answer to a payer landscape that’s continues to evolve.
Self-insured employers, navigation platforms and specialty associations are increasingly negotiating surgical care directly rather than through traditional commercial plans. Meanwhile, 37% of employers already offer their workers a healthcare navigation platform, as 89% said they’re actively taking steps to control costs, according to a study from Quantum Health and Employer Benefits News.
Marie Edler, SCA Health’s chief growth officer, joined Becker’s to discuss how her team is approaching “nontraditional payers.”
“When we refer to nontraditional payers, we’re acknowledging that the healthcare ecosystem around specialty care and surgery is expanding,” Ms. Edler said. “Employers, payers, navigation platforms, specialty associations and other groups are organizing in a structured way we didn’t see five or 10 years ago, driven by rising healthcare costs. They’re finding ways to directly engage patients, employers and provider networks, and that puts different requirements on us as an enterprise. It requires us to bring our surgeons along and create space for types of care that may have access restrictions in a given market.”
On its website, the company describes its value-based contracting as spanning “the full risk spectrum,” from quality incentives and shared savings arrangements to bundled payments and capitation models, alongside HiVE, its proprietary branded program built around what SCA Health calls “transforming specialty care.”
Ms. Edler said SCA Health has several pilots underway with these newer payer types, and that early results are positive. She sees this as an early version of something bigger as patients are beginning to choose where and how they get surgical care by themselves, the way they already do with urgent care and concierge medicine.
“Pay-for-performance and better outcomes and experience could really take hold in some of these models,” Mr. Edler said. “Patients will start to require it in a way the older generation didn’t know they could expect or influence. Technology-driven decisions on where and how patients rate the provider and site of care they want is still largely unheard of. That direct-to-consumer model hasn’t really taken off yet, but I think we could see real advances in that mentality and in consumer choice over the next five-plus years.”
With 60-plus health system partners and a named value-based model already running in market, SCA Health has more infrastructure in place for that shift than most ASC operators.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
