Long Island physicians to form value-based kidney care group

A group of 30 medical providers with patients on Long Island and in Queens has created a new medical group, PRINE Health, that will work to manage the complex and costly care of patients with chronic kidney disease.

The group, which will launch officially May 1, is made up of nephrologists, primary care physicians and complementary providers who will bill insurers through PRINE and use the same electronic medical records system.

The 30 providers care for 40,000 patients with chronic kidney disease and 1,000 with end-stage renal disease at eight locations. Those patients spend more than $500 million a year on health costs.

The group receives administrative support from its own Manhasset-based management services organization, which provides both typical business services, such as HR, marketing and managed-care contracting as well as population health services. PRINE's MSO will deliver the type of data analytics, care-management and home-care services that has the potential to keep patients' kidney health from deteriorating.

The group is led by CEO Dr. Simon Prince, a board-certified nephrologist who previously founded and sold accountable care organization Beacon Health to Catholic Health Services. Prince also explored founding a Medicare Advantage plan in 2016 but ultimately had trouble building a network and returned money to investors before ever selling health plans.

Now Prince is back to what he knows best: kidney care. PRINE's goal is to take on risk-based contracts with insurers for which it is responsible for managing members' health costs and preventing patients with kidney disease from losing so much of their kidney function that they require dialysis. Diabetes and high blood pressure are common causes of kidney disease.

"This is a high-cost patient population that has a ton of co-morbidities," Prince said. "There are a lot of gaps in care that we would be positioned to plug."

If patients do require dialysis, the group can help manage those costs as well, with 10 of its doctors serving as medical directors at 18 dialysis centers.

Medicare, the largest payer for this patient population, has expressed interest in changing the way it pays for kidney care, which represented one-fifth of its spending, or $113 billion, in 2016, Modern Healthcare reported. HHS Secretary Alex Azar said last month that more dialysis care should be delivered at home, not at outpatient centers, and he expressed support for end-stage renal disease seamless care organizations, or ESCOs.

On the commercial insurance side, Prince said, the group has contracts with major payers, including Aetna, EmblemHealth and UnitedHealthcare. Typically in value-based payment arrangements, patients are attributed to the provider with whom they receive the most services or spend the most money. For this reason, recruiting more primary care doctors will be important, Prince said.

Parker Jewish Institute is an initial minority investor, with PRINE's physician partners also investing in the company. Parker Jewish Institute in New Hyde Park runs the managed-care plan AgeWell New York and the Queens Long Island Renal Institute, a dialysis center.

Thomas D'Aunno, director of the health policy and management program at NYU's Wagner Graduate School of Public Service, said insurers are definitely interested in doctors taking on financial risk for the costs of their patients. He said the group would need strong leadership to get all its doctors practicing in the most cost-effective ways.

"Everyone, but especially CMS, has been aggressive about wanting to do something about the high cost of kidney care," D'Aunno said. "That's why I think they're in a good space here.

"It's all about execution," he added.