Healthcare Analytics, Population Health Management, Healthcare Big Data

Population Health News

Private Payers Driving Value-Based Payment, Accountable Care

By Jennifer Bresnick

- Commercial health plans are at the forefront of industry-wide efforts to improve care coordination and embrace value-based payment, writes Karen Ignagni, MBA, President and Chief Executive Officer, America’s Health Insurance Plans (AHIP) in an editorial for the American Journal of Managed Care, and are a crucial part of the nation’s efforts to reduce extraneous spending and raise the level of quality care.

By leveraging healthcare data analytics, innovative reimbursement structures, and patient-centric outreach for population health management, payers are providing a backbone of support for healthcare organizations facing numerous challenges on the front lines of care delivery.

“Today, health plans are employing a multi-faceted approach to care coordination and disease management. With detailed data analysis, health plans are working with clinicians to identify gaps in care and to provide personalized support for patients managing chronic conditions,” Ignagni says.

AHIP members have come out in favor of newly announced federal efforts to transition significant portions of Medicare reimbursement into value-based payment arrangements, something private industry has been investigating and investing in for some time before Secretary Burwell’s pledge.   Accountable care organizations and value-based payment agreements between providers and payers have been proliferating rapidly over the past several years, with new partnerships developing almost every week.

Ignagni adds that AHIP health plans are also planning to participate in collaborations focused on spreading knowledge and experience about care innovations such as patient-centered medical homes, bundled payments, and other alternative payment models that promote quality, patient safety, and lower costs.

Some payers are already experimenting with putting bundled payments and reimbursement for episodes of care into action, and they have seen financial rewards for doing so, especially in complex care areas like oncology.  UnitedHealthcare, for example, was able to reduce the costs of care for breast, lung, and colon cancers by more than one third when oncologists enrolled in a pre-determined payment schedule for common treatments.

CMS recently followed in their footsteps by offering a similar value-based payment program for oncologists, offering physician-led organizations a bundled payment and monthly care management payment for Medicare cancer patients.

“As these innovations evolve, health plans are also directly connecting with patients to make certain that they have the support, information, and decision-making tools they need to navigate the healthcare system,” she adds. “Our unique ability to help individuals across the care continuum—from the time patients make that first doctor’s appointment to when they visit a specialist to help them to manage a chronic disease—is what enables health plans to ensure that patients receive the best value for their care.

“From cost calculators to 24/7 nurse hotlines, health plans are integrating new technology and partnering with digital experts to deliver personalized support that patients rely on when it comes to making their healthcare choices,” Ignagni writes.

Patient engagement and population health management programs originating from the payer side may help to reduce the administrative and financial burden on providers who wish to deliver similar services to their patients, but lack the time, manpower, or budget to do so.  Working together from both angles can help the healthcare industry deliver on its promises to better coordinate care, provide more comprehensive primary care and preventative care services, and improve chronic disease management to contain spending on some of the most costly conditions patients may face over their lifetimes.

“These efforts complement new benefit structures and payment arrangements that promote disease prevention and consistent monitoring so that patients receive the appropriate care at the right time,” Ignagni concludes. “The results of these reforms are clear: better health outcomes for patients, more efficient care delivery, and improved value overall.”


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