Health Plan’s Role in Provider Alignment
Long gone are the days when the provider contracting functions, the medical economics function and the health services/medical management functions within a Health plan could operate in their own separate environment with limited interaction. Health plans today are pressured to provide improved member access to health services at reduced cost while striving for improved treatment outcomes for their members. Consequently, health plans are being asked to motivate their providers to adjust practice patterns in ways that support performance based outcomes and shifts emphasis from procedure based reimbursement to value based reimbursement. That can only be accomplished successfully if the dynamics between providers and Health Plans evolve from adversarial to one of shared interest, collaboration and shared decision making.
Give health plans and the provider community credit for recognizing such and having made significant strides in aligning their own interests, as well as their memberships interests, with those of the provider community. Witness collaborate efforts such as ACOs, patient centered medical homes, bundled payment initiatives and other innovative payment programs. Just today United announced an ambitious five year initiative to contract 50 billion dollars of commercial health insurance contracts with ACOs nationwide. Similarly, CMS is committed to publishing on an annual basis Hospital charges to demonstrate the huge disparities in hospital pricing for the same procedures across the country with the hope of eventually motivating hospitals to bring rationality to inpatient services pricing.
Resources:
At GHG we have a history of helping all stakeholder organizations engaged in providing better health outcomes efficiently and in the best possible setting. Come join us.
A rapidly growing number of provider organizations, especially those involved in accountable care organization (ACO)-type arrangements, are deciding to get into Medicare Advantage. Join us for a webinar on August 8 to get practical advice on the best ways of getting into the MA market.
Read more on ACO opportunities in our white paper on the topic.