Pearl Health and Wellcare Announce Partnership to Advance Value-Based Care Access in Primary Care

Rhea-AI Summary

Pearl Health and Wellcare, a Medicare brand of Centene Corporation, have announced a new partnership to advance value-based care in collaboration with primary care physicians. The multi-year Medicare Advantage partnership aims to improve health outcomes and control costs for Wellcare Medicare Advantage members through innovative value-based care models.

Insights

Healthcare Policy Expert

The partnership between Pearl Health and Wellcare represents a significant stride in the evolution of value-based care (VBC) models. The transition from fee-for-service to VBC is a fundamental shift in healthcare reimbursement, incentivizing providers to focus on the quality rather than the quantity of care. By sharing increased financial risk, Pearl Health and Wellcare are aligning incentives with patient outcomes, which could lead to more efficient healthcare delivery and potential cost savings for the Medicare system.

From a policy perspective, this collaboration could serve as a blueprint for future private-sector initiatives in the Medicare Advantage space. By leveraging Pearl Health's technology and data insights, the partnership is poised to enhance the ability of primary care physicians to manage care more effectively, potentially leading to improved clinical outcomes for Medicare Advantage members.

Healthcare Technology Analyst

The integration of Pearl Health's technology into Wellcare's Medicare Advantage plans is a pivotal development in healthcare IT. Pearl's platform, which offers data insights, financial tools and practice enablement, is designed to empower clinical teams to deliver proactive, whole-patient care. The scalability of this technology is critical, as it facilitates the expansion of advanced VBC arrangements nationwide.

For stakeholders, the deployment of such technology could translate into enhanced operational efficiencies and stronger financial performance, particularly as primary care physicians optimize patient panel management. The ability to better control costs while improving quality care is a substantial value proposition that could differentiate Wellcare in a competitive Medicare Advantage market.

Financial Analyst

The announcement of this partnership could have material implications for the financial health of both Pearl Health and Wellcare's parent company, Centene Corporation. As the program scales, the financial risk-sharing component may lead to variable financial outcomes. Success in improving health outcomes and controlling costs could result in improved margins and potentially enhanced shareholder value for Centene.

Investors should monitor the rollout of this partnership, particularly in South Carolina as an initial market, for early indicators of success. Positive results could signal an effective model for expansion and possibly influence the stock performance of Centene Corporation. Conversely, challenges in implementation or cost control could necessitate adjustments to the strategy.

TAMPA, Fla. and NEW YORK, March 12, 2024 /PRNewswire/ -- Pearl Health, a leading technology company focused on physician enablement and risk bearing in value-based care, and Wellcare, the Medicare brand of Centene Corporation (NYSE: CNC), announced today a new partnership to advance value-based care in collaboration with primary care physicians.

The multi-year Medicare Advantage partnership establishes a pathway to sharing increased financial risk, which allows the two organizations to accelerate their collaboration on several innovative initiatives — including value-based care (VBC) models — designed to improve health outcomes and better control costs for Wellcare Medicare Advantage members.

Pearl Health offers data insights, financial tools, practice enablement technology, and a broad range of value-based care services to empower clinical teams to provide more proactive, whole-patient care — giving primary care providers participating in Wellcare's networks the tools and support they need for success in value-based care. The program is already live in South Carolina, and the partnership with Wellcare sets the stage for expansion nationwide as primary care physicians look for greater support in transitioning more of their panel to advanced value-based care arrangements.

"We are pleased to deploy a value-based partnership with Pearl as we work together to improve quality and clinical outcomes for our diverse and complex Medicare Advantage members," said Centene's Medicare CEO, Michael Carson. "We look forward to success as we work collaboratively in South Carolina for Medicare Advantage members."

"This partnership enables Pearl to expand its technology and capabilities across both Traditional Medicare and Medicare Advantage plans," said Michael Kopko, CEO & co-founder of Pearl Health. "With Wellcare's partnership, physicians will now be able to manage their patient panel — focusing on improving quality and lowering costs — more efficiently across a growing portion of their Medicare population."

About Wellcare

For more than 20 years, Wellcare has offered a range of Medicare products, including Medicare Advantage and Medicare Prescription Drug Plans (PDP), which offer affordable coverage beyond Original Medicare. Wellcare is the Medicare brand of Centene Corporation, a leading healthcare enterprise committed to helping people live healthier lives. Beginning Jan. 1, 2022, Centene's Medicare brands, including Allwell, Health Net, Fidelis Care, Trillium Advantage, 'Ohana Health Plan and TexanPlus transitioned to the Wellcare brand. For more information about Wellcare, visit www.wellcare.com. 

About Pearl Health

Pearl Health is democratizing access to value in healthcare. Led by provider enablement, risk-bearing, and technology experts, Pearl offers software and services that help providers reimagine how they visualize, understand, and care for their patients. Pearl supports primary care organizations and providers in their transition to value-based care and surfaces data and insights that help them deliver better, more proactive care, decrease total cost of care across patient panels, and optimize performance in risk-bearing models like Medicare's ACO REACH. Since its founding in 2020, Pearl has raised approximately $100M in funding from investors such as Andreessen Horowitz, Viking Global Investors, AlleyCorp and SV Angel, and has grown to serve providers across the United States. Learn more at www.pearlhealth.com.

Media Contacts 

Pearl Health:

Dan MacLeod
Director, Product Marketing, Pearl Health
240-603-2887
dan.macleod@pearlhealth.com

Wellcare:

mediainquiries@centene.com

Forward-Looking Statements

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In particular, these statements include, without limitation, statements about our future operating or financial performance, market opportunity, competition, expected activities in connection with completed and future acquisitions and dispositions, our investments and the adequacy of our available cash resources. These forward-looking statements reflect our current views with respect to future events and are based on numerous assumptions and assessments made by us in light of our experience and perception of historical trends, current conditions, business strategies, operating environments, future developments and other factors we believe appropriate. By their nature, forward-looking statements involve known and unknown risks and uncertainties and are subject to change because they relate to events and depend on circumstances that will occur in the future, including economic, regulatory, competitive and other factors that may cause our or our industry's actual results, levels of activity, performance or achievements to be materially different from any future results, levels of activity, performance or achievements expressed or implied by these forward-looking statements. These statements are not guarantees of future performance and are subject to risks, uncertainties and assumptions. All forward-looking statements included in this press release are based on information available to us on the date hereof. Except as may be otherwise required by law, we undertake no obligation to update or revise the forward-looking statements included in this press release, whether as a result of new information, future events, or otherwise, after the date hereof. You should not place undue reliance on any forward-looking statements, as actual results may differ materially from projections, estimates, or other forward-looking statements due to a variety of important factors, variables and events including, but not limited to: our ability to design and price products that are competitive and/or actuarially sound including but not limited to any impacts resulting from Medicaid redeterminations; our ability to maintain or achieve improvement in the Centers for Medicare and Medicaid Services (CMS) Star ratings and maintain or achieve improvement in other quality scores in each case that can impact revenue and future growth; our ability to accurately predict and effectively manage health benefits and other operating expenses and reserves, including fluctuations in medical utilization rates; competition, including for providers, broker distribution networks, contract reprocurements and organic growth; our ability to adequately anticipate demand and provide for operational resources to maintain service level requirements; our ability to manage our information systems effectively; disruption, unexpected costs, or similar risks from business transactions, including acquisitions, divestitures, and changes in our relationships with third parties; impairments to real estate, investments, goodwill, and intangible assets; changes in senior management, loss of one or more key personnel or an inability to attract, hire, integrate and retain skilled personnel; membership and revenue declines or unexpected trends; rate cuts or other payment reductions or delays by governmental payors and other risks and uncertainties affecting our government businesses; changes in healthcare practices, new technologies, and advances in medicine; increased healthcare costs; inflation and interest rates; the effect of social, economic, and political conditions and geopolitical events, including as a result of changes in U.S. presidential administrations or Congress; changes in market conditions; changes in federal or state laws or regulations, including changes with respect to income tax reform or government healthcare programs as well as changes with respect to the Patient Protection and Affordable Care Act and the Health Care and Education Affordability Reconciliation Act (collectively referred to as the ACA) and any regulations enacted thereunder; uncertainty concerning government shutdowns, debt ceilings or funding; tax matters; disasters, climate-related incidents, acts of war or aggression or major epidemics; changes in expected contract start dates; changes in provider, broker, vendor, state, federal, foreign, and other contracts and delays in the timing of regulatory approval of contracts, including due to protests; the expiration, suspension, or termination of our contracts with federal or state governments (including, but not limited to, Medicaid, Medicare or other customers); the difficulty of predicting the timing or outcome of legal or regulatory audits, investigations, proceedings or matters, including, but not limited to, our ability to resolve claims and/or allegations made by states with regard to past practices, including at Centene Pharmacy Services (formerly Envolve Pharmacy Solutions, Inc. (Envolve)), as our pharmacy benefits manager (PBM) subsidiary, within the reserve estimate we previously reported and on other acceptable terms, or at all, or whether additional claims, reviews or investigations will be brought by states, the federal government or shareholder litigants, or government investigations; challenges to our contract awards; cyber-attacks or other data security incidents; the exertion of management's time and our resources, and other expenses incurred and business changes required in connection with complying with the terms of our contracts and the undertakings in connection with any regulatory, governmental, or third party consents or approvals for acquisitions or dispositions; any changes in expected closing dates, estimated purchase price, or accretion for acquisitions or dispositions; losses in our investment portfolio; restrictions and limitations in connection with our indebtedness; a downgrade of our corporate family rating, issuer rating or credit rating of our indebtedness; the availability of debt and equity financing on terms that are favorable to us; and risks and uncertainties discussed in the reports that Centene has filed with the Securities and Exchange Commission (SEC). This list of important factors is not intended to be exhaustive. We discuss certain of these matters more fully, as well as certain other factors that may affect our business operations, financial condition and results of operations, in our filings with the SEC, including our annual report on Form 10-K, quarterly reports on Form 10-Q and current reports on Form 8-K. Due to these important factors and risks, we cannot give assurances with respect to our future performance, including without limitation our ability to maintain adequate premium levels or our ability to control our future medical and selling, general and administrative costs.

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SOURCE Pearl Health

FAQ

What is the partnership between Pearl Health and Wellcare about?

The partnership aims to advance value-based care in collaboration with primary care physicians, focusing on improving health outcomes and controlling costs for Wellcare Medicare Advantage members.

What services does Pearl Health offer in the partnership?

Pearl Health offers data insights, financial tools, practice enablement technology, and a broad range of value-based care services to empower clinical teams in providing proactive, whole-patient care.

Where is the program currently live?

The program is already live in South Carolina, with plans for expansion nationwide.

How does the partnership benefit physicians?

Physicians will now be able to manage their patient panel more efficiently, focusing on improving quality and lowering costs across a growing portion of their Medicare population.

Who is Centene's Medicare CEO?

Michael Carson is Centene's Medicare CEO.

Who is the CEO & co-founder of Pearl Health?

Michael Kopko is the CEO & co-founder of Pearl Health.