Finding balance: Honest liberates physicians while working alongside payers

After 25 years as a “health plan guy,” Andy Marino knew Honest Medical Group could actually help the industry think differently: to empower and unleash physicians to practice the type of medicine they want — and need — to practice for themselves and their patients, and collaborate with health plans to achieve their objectives, both clinically and financially.”

The problem became painfully clear and hit too close to home for Marino as he saw how the current health care system failed a close family member with a chronic condition. This family member was struggling, and even though her Medicare Advantage plan provided home-based visits through a vendor, she still had multiple hospital stays each year — all of which could have been prevented with earlier intervention and meaningful collaboration with her primary care physician.

“The health plan’s vendor did a good job documenting risk factors but fell short of translating this information into a care plan and sharing key insights and needs with my family member’s physician to drive better outcomes,” says Marino. “They treated the home visits as a data-gathering expedition while losing sight of the real reason for the program. That, in my eyes, is emblematic of a broken system.”

Marino joined Honest in 2021 as the senior vice president of payer strategy and delivery networks to accelerate the industry’s value-based care transformation. “The physician-patient relationship is the center of the universe at Honest,” says Marino. He wants to work with payers who share that vision and are committed to reinventing themselves as organizations that support physicians as they take on accountability for cost, quality, outcomes, and experience. “This is the impact I am trying to have after seeing how much work we all have to do to realize the potential of physician-led, value-based care.”

Connecting the value

In his role, Marino oversees three key areas: private payer strategy, public payer care delivery networks, and physician data integrity. Marino negotiates risk contracts with private payers that empower primary care physicians (PCPs) to deliver whole-person care. “I speak payer; I know their pain points and challenges, but through collaboration, we can achieve optimal outcomes for all parties,” says Marino. “Often, value creation and value reward are disconnected. My goal is to better align the creation and sharing of value to the benefit of patients and physicians.”

When he is not working with payer partners, Marino’s team is focused on empowering physicians. The Honest model helps PCPs extend the reach of their practices into the patient’s home with programs like Care at Home, Care in Motion, and the Clinical Documentation Improvement Program. From his past experiences, Marino is always thinking about the entire ecosystem.

“It takes a village to transform health care. How do we collaborate with specialists, hospitals, and ancillary providers to support the PCP with timely access, consultations, shared data, and more?” he asks.

Marino’s own reach goes beyond his work at Honest. As a proud Health Care Transformation Task Force board member, he provides valuable feedback to the Centers for Medicare & Medicaid Services to better support this physician-patient relationship and new payment models.

Liberating physicians through collaboration

Marino sees how Honest can support physicians in ways other organizations can’t.

“At Honest, our speed, agility, focus, and urgency enable us to drive transformational change, which can be a challenge for legacy organizations who typically focus only on incrementable improvements,” he says.

Honest can help PCPs:

• Keep the value they create. Value sharing between payers and physicians can become lopsided. Honest empowers physicians clinically and through total cost of care and quality compensation models and repositions how value creation is shared with our primary care partners.
• Recognize their market power with payers. “Most physicians don’t realize the critical role they play in a payor’s product offering and how much payers rely on them to support profitable growth during key selling seasons, like the Annual Enrollment Period,” says Marino.

“We help our physician partners recognize their role in the health care ecosystem and reframe how they work with their payor partners who are open to these next-generation payor-provider relationships.”

• Move from managed care to managed life. The legacy fee-for-service model hinders a whole-person approach to care. The shift to risk (with support from Honest) allows PCPs to practice the medicine they want to. These models liberate care delivery because revenue is no longer exclusively tied to the codes a practice bills for reimbursement. Value-based payment models allow us to better leverage the investments the Medicare Advantage plans have made in supplemental benefits to support seniors in ways that extend beyond the traditional medical and pharmacy benefits.
• Realize a doctor-driven experience. Through deep health plan expertise and an operating model that extends the reach of our PCP partners, “Honest creates the much-needed bridge between payers and physicians,” says Marino. “A bridge that ultimately benefits the patients and our physician partners, which is why I’m here.”

Partnering with a purpose

Risk contracts have the potential to reframe a practice’s operating model and expand its clinical offerings. However, executing this strategy is challenging without a partner, and assuming down-side risk can be dangerous without the experience and expertise that traditionally sits within the health plans.

Honest serves as the trusted partner for practices looking to accelerate their value-based care transformation.

“We’ll work together to translate revenue from these risk models into opportunity, new capabilities, and a path toward being liberated from the fee-for-service flywheel. It is a freeing experience for all the partners, and I am excited to be a part of it,” says Marino.

Contact Honest to see how we can liberate you and your practice with the resources and support you need to excel in full-risk arrangements while enhancing patient outcomes.