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Health Plans
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Health Plans

It is time for health plans to shift to a new mindset focused on value. Today’s forward-looking health plans are beginning to see the rewards of engaging in value-based competition by supporting informed patient and physician choice, measuring and rewarding providers based on outcomes, maximizing patient value over the full cycle of care, minimizing paperwork, and competing for subscribers based on the ability to achieve positive health outcomes.

 

Implications for Health Plans in a Value-Based Health Care Delivery System

  1. Encourage and reward integrated practice unit models by providers
  2. Encourage or mandate provider outcome reporting through registries by medical condition
  3. Create standards for meaningful provider cost measurement and reporting
  4. Design new bundled reimbursement structures for care cycles instead of fees for discrete services
  5. Share information with providers to enable improved outcomes and cost measurement
  6. Assist in coordinating patient care across the care cycle and across medical conditions
  7. Direct care to appropriate facilities within provider systems
  8. Provide advice to patients (and referring physicians) in selecting excellent providers based on data
  9. Create relationships to increase the volume of care delivered by or affiliated with centers of excellence
  10. Assemble, analyze, manage members’ total medical records
  11. Require use of interoperable medical records
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