"Businesses that produce paint or provide legal services never planned to be at the nexus of efforts to fix a health care system in need of a makeover. But as employers, that's where we find ourselves. As the biggest purchasers of private health insurance, we've got a big stake in making health care work like we all want it to."
Tim Kowalski, MD
Chief Medical Officer, Progressive Insurance
President, Health Action Council Quality Forum
in Crain's Cleveland Business
Redesigning the Future of Healthcare, Part I
October 11, 2011
Harold D. Miller
Primary Care Delivery and Payment System Changes
All health care purchasers want to buy services that provide timely access to coordinated care, promote wellness and prevention and deliver positive patient experiences for employees and their dependents — all of which should keep them from needing costly hospital care.
On October 11, 2011, leaders from across the region and stakeholder groups considered various models of payment for primary care services that hold the promise of delivering the outcomes we want: better care, better health and lower cost by avoiding many hospitalizations. Recommendations emerged from the all-day Summit for care and payment models for different patient populations, and Task Groups were formed to take the work forward.
Redesigning the Future of Healthcare, Part II
SAVE THE DATE: May 1, 2012
A. Mark Fendrick, M.D.
Designing Insurance Benefits for Greater Value
Aligning Enrollee Incentives with Payment and Delivery System Change
Insurance plans that encourage employees and health plan enrollees to stay healthy and use health care resources wisely can accelerate improved outcomes and lower costs, particularly when benefit design is well aligned with payment and health care delivery change.
Benefit design features that encourage healthier behaviors and lower costs include financial incentives for enrollees who:
- Choose health care providers who achieve national standards for quality care and document preventive care; improve access through same-day appointments or electronic communications; provide care coordination and document positive patient experiences;
- Adhere to evidence-based treatments for chronic disease;
- Receive recommended preventive care;
- Avoid unnecessary visits to Emergency Departments;
- Choose generic over name-brand drugs
Regional efforts that are underway include the Cuyahoga County Health Alliance, which has welcomed municipal governments to participate in county initiatives to redesign its employee benefits. Value-based benefit design is a core element of Better Health’s work with employers and health plans to establish a multi-payer program with primary care practices that adopt the Patient Centered Medical Home model.
Invited participants to the Summit on May 1 will learn about various benefit design elements, current evidence of impact on outcomes and cost, and will craft recommendations that align with payment and delivery mechanisms recommendations generated on October 11, 2011.