Forward Health
Group’s Role

THE MEASUREMENT PARTNER — BETWEEN FIERCELY INDEPENDENT NETWORKS AND THE PLANS THAT PAY FOR THEM

Barbara McAneny, MD has set out to build something patient and large: a nationwide network of independent oncologists — and then, on the same path, nationwide networks of the other independent specialists the consolidators have squeezed. A health plan and an independent network have rarely had reason to trust one another. Forward Health Group helps support that work — aligning them on a single incentive, so each is rewarded when outcomes improve, and showing, on the plan’s own data, that the savings are real. None of this is a simple path — but it is a navigable one, taken smartly and together.

THE THESIS, IN ONE LINE

Barbara is building the network. Forward Health Group helps support it — aligning the plan and the network on one incentive, and showing, on the plan’s own data, what the network saves and where it should grow.

HOW FHG IS PAID — AND HOW IT ISN’T

Forward Health Group is paid by the health plans — never by Barbara or ONCare.

Barbara and ONCare are never the source of Forward Health Group’s reimbursement. That reimbursement is always transparent, and it comes from the health plans. It does not draw on the ONCare funding pool, and it places no tax on the physicians in Barbara’s network. Rather, it is the funding that helps the network grow — and that, in turn, increases the revenue sharing returning to ONCare.

WHAT IT IS NOT

Never paid for by Barbara or ONCare
No draw on the ONCare funding pool
No tax on the network’s physicians

WHAT IT IS

Paid transparently by the health plans
Funding that helps the network grow
More revenue sharing returning to ONCare

THE BRIDGE

Barbara’s Independent Network

NMOHC and the New Mexico CIN today; a national footprint as it grows

Forward Health Group

the measurement partner — the bridge

The Health Plans

HCSC / BCBS New Mexico the national pioneer — and the Blues that follow the leader

Built on Solventum’s Clinical Risk Groups (CRGs) — the claims grouping the plans already license — so the bridge extends to each new specialty, each new practice, and each new plan.

WHY HCSC GOES FIRST — THE PIONEER’S SEAT

The national pioneer

HCSC sets the model the other Blues follow. The executives who champion it are the ones who led — and their standing is enriched by being first, not last.

No harm, no foul

It begins as a contained pilot — on the plan’s own claims, in the plan’s own environment, with no downside risk — proving the savings before anything scales.

A competitive edge

Keeping independent oncology alive means better cancer access at lower cost — an advantage HCSC holds over United and Humana, who are squeezing the very same practices.

And the economics hold: the plan may pay the physician side a little more — correcting today’s underpayment — and recovers it many times over from the hospital systems, once the true cost of optimal care is known.

THE DATA FLOW — TWO STREAMS, ONE LENS

ONCare’s shared data engine

the network’s EHR data across practices — gathered into a rich, real-time flow (Zoadigm’s platform), so clinicians focus on care

The plan’s claims

the payor’s full cost picture — where the money actually goes

FORWARD HEALTH GROUP

One rich lens

ONCare’s shared data engine and the plan’s claims, resolved into one view — for the first time the practice sees the downstream, on the plan’s own data.

Back to the practices

where the gaps are, who to coordinate, what to fix

Back to the plan

the PMPM saved, and where the network should grow next

What this brings into view: the same cardiac echo, ordered in-network, can cost four times as much in one place as another — and today that difference goes unseen. Seen in one view, the waste can be removed, and what is saved becomes the shared source that funds both the plan’s growth and the network’s.

Zoadigm plays an important role on this side — its platform turns the plan’s onerous requirements into background workflow at the practice, so clinicians spend their time on patients, not prior authorizations and paperwork.

THE NETWORK, GROWING

Members receiving care under Barbara’s model

PROVING GROUND · TODAY

NMOHC

The proven independent oncology practice — the COME HOME heritage that keeps patients out of the hospital and the ED.

Members under the model

NEAR-TERM · BUILDING

New Mexico Independent Doctors

Barbara’s separate New Mexico vehicle — a first-of-its-kind multi-specialty CIN, alongside the ONCare oncology alliance, not part of it. Not built on a hospital or on primary care. It controls specialty access in its market, so the plans that contract get priority — shifting the balance of power. One contract; CKD the start-small demonstration.

OncologyGIRenal GYN-OncOphthalmologyDermatology ASC

Members under the model

THE VISION · NATIONAL

ONCare Alliance

A nationwide network of independent oncologists — then, on the same playbook, nationwide networks of other disaffected independent specialists, settled on infrastructure the plans already hold.

Members under the model

The path out runs through HCSC’s own footprint — New Mexico first, then Illinois, Texas, and Oklahoma — to the ONCare practices within it, and outward to the broader Blue Cross Blue Shield Federation.

WHAT FHG DOES

One incentive

Holds the plan and the network to one shared measure — value created by removing waste, not by adding volume — so neither must take the other on trust.

Avenues for growth

Shows, on the plan’s own claims, where patients leak to higher-cost settings and where the network has gaps — so the plan sees where helping Barbara expand returns most.

An independent calculation

Measures the PMPM the model has already taken out — independently, on a calculation neither side can tilt — and projects what a larger network would save, so the network keeps its share and control never shifts to the plan.

FHG measures the outcome; Zoadigm operationalizes the care — the workflow and coordination layer that keeps practices focused on care delivery, not the plan’s administrative machinery. Complementary lanes, one aligned model.

WHAT WE NAVIGATE — TOGETHER

THE SPEEDBUMPS

A plan this large moves carefully. Security and privacy review is rigorous — no payor wants to be the next headline breach.
Most of HCSC’s oncology already runs through an incumbent vendor (Carelon). Anything new has to fit around what is already in place.
At Enterprise scale there is little appetite for custom builds — a proposal has to run on systems the plan already operates.
The macro pressure is real and arriving at once: Medicaid cuts, fee-schedule pressure on Part B, and the IRA’s hit to drug-margin economics.

HOW WE GET THROUGH, TOGETHER

We ask the plan to build nothing. We turn on what they already license — Solventum’s CRGs are already contracted in.
The work runs on the plan’s own claims, in the plan’s own environment; the data never leaves their house — exactly what a security review needs to hear.
The cleanest on-ramp avoids the multi-year security review entirely: the plan funds Barbara’s already-in-network practice to stand the work up — no new vendor ever takes the plan’s data.
HCSC / BCBS New Mexico goes first as the national pioneer — proving it small, no harm no foul, then leading the Blues that follow.
The measurement partner sits alongside, independent and paid by the plan, so the network carries no new IT lift and no new cost.

The honest read: this is not plug-and-play. It is a path with real obstacles — and a path that has been walked before, on infrastructure the plan already holds. Taken in the right order, with the right partner, it is one we get through smartly, together.

THE THESIS, IN ONE LINE

CRGs, IN PLAIN TERMS

Clinical Risk Groups are Solventum’s method for sorting a covered population into clinically coherent risk groups. Health plans already license and run them — so settling chronic-disease care on CRGs means switching on something the plan already has, not building something new. The work runs on the plan’s own claims, in the plan’s own environment; the data stays the plan’s.

NEXT STEP

A short conversation — Barbara and Michael — to align on FHG’s role and to accelerate and advance Zoadigm’s growth and adoption, with HCSC / BCBS New Mexico as the national pioneer. Not a simple path — but one we navigate smartly, together.