Company Background

  • The journey of Piedmont Healthcare and WellStar Health System started independently. But, both started about five years ago exploring ways to provide clinically integrated accountable care. As each organization continued to move into population health management and the industry continued to move from fee-for-service to value-based care, it became more apparent that greater success would come if we were accountable for the full risk and benefited from all the benefits.
  • Separately, Piedmont and WellStar were assessing the traditional payor relationships in the market including but not limited to gainshare, accountable care organizations (ACO), and bundled payment arrangements. It became apparent that the payors were not ready at that point for a new type of relationship and these relationships did not have the flexibility for care innovation and enough financial impact to offset potential challenges associated with the current payment models, health reform, and Medicare reimbursement changes. Both organizations realized the benefit of doing this on a larger scale rather than separately to maximize the ability to further the care for individuals in its communities through a new option. After a period of thoughtful consideration, agreement was reached in December of 2012 to form a joint venture health plan called Piedmont WellStar HealthPlans.

Objectives for the joint venture included:

  • Create a provider-owned vehicle to offer health insurance to serve the greater Atlanta market and/or targeted, sustainable geographies.
  • Continue to build on the clinically integrated, accountable care activities already started by both systems through a population management infrastructure to engage patients with aligned physicians and hospitals.
  • Find other like minded healthcare affiliates to join a network dedicated to superior clinical performance, customer service, and cost effectiveness in an integrated framework.
  • Serve the employee, Medicare, and commercial markets with this health infrastructure that provides higher quality care at a more affordable cost.
  • Expand market-wide access to services offered by Piedmont and WellStar.