UPMC Health Plan & InterWell Health Launch Value-Based Agreement to Coordinate Care for UPMC Health Plan Members

(Pittsburgh, Penn.) – Oct. 12, 2022

UPMC Health Plan and InterWell Health today announced a new joint initiative to integrate care coordination services and enhance education and self-management strategies for UPMC Health Plan members with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). The initiative will cover members across multiple insurance products, including commercial and Medicare Advantage members.

The agreement reflects UPMC Health Plan’s ongoing priority to reward providers for improving the health of its members using alternative payment models. Under such models, providers are incentivized to work with members to improve health outcomes and deliver the right care at the right time in the most appropriate setting.

“With this health outcomes-driven initiative in place, UPMC Health Plan members with chronic kidney disease have the peace of mind knowing that the complex needs related to their condition are being managed in a proactive, clinically informed manner that is intended to reduce hospitalizations, the likelihood of starting dialysis, and better prepare candidates for transplant,” Dr. James Schuster, Chief Medical Officer, UPMC Health Plan, said. “The member-focused effort reflects our continued commitment to health plan programs that best meet the practical and clinical needs of our members.”

“We are excited to partner with UPMC Health Plan to help their members with kidney disease better navigate what can be a fragmented care delivery system and live their best lives,” said Dr. George Hart, Chief Medical Officer of InterWell Health. “We support these members with real-time access to multidisciplinary care teams and peer mentors, all in close partnership and coordination with our network of high performing nephrologists.”

Under the agreement, InterWell Health will work with providers to integrate care management plans and work directly with members to make sure they are receiving optimal care and healthy lifestyle supports – all of which can be challenging and confusing for members. This initiative reflects published studies indicating that optimizing treatment for individuals with kidney disease can delay the need for dialysis by several years.

In addition to potentially delaying the time when some members with kidney disease have to receive dialysis or undergo transplants, the coordinated care approach also increases supports for members to receive dialysis in their homes instead of in special dialysis facilities.