Insurers Embrace More Active Role in Value-Based Care

Published Online: July 03, 2014
Katie Sullivan, MA
Although some providers still operate under the traditional fee-for-service reimbursement model, that is likely to change. Payers, employers, and government agencies are increasingly choosing to reward value over volume.

In fact, a recent study from the Medical Group Management Association (MGMA)—the largest organization comprised of physician practices in the United States —found that insurers paid both primary care physicians and specialists more based on the quality of care they delivered. The group, which examined an estimated 66,000 medical care providers, reported that the median compensation for primary care doctors rose from $220,942 in 2012 to $232,989 in 2013. For specialists, their compensations rose from $396,233 in 2012 to $402,233 in 2013. Even primary care doctors and specialists who were not a part of accountable care organization or patient-centered medical homes, said that nearly 6% of the increase to their compensation was a result of meeting or exceeding quality metrics. 

“Physicians are providing quality care to their patients, so it’s not surprising that compensation methodologies are evolving to incorporate these metrics,” said Dr. Susan Turney, president and chief executive of the MGMA.

Insurers aren’t only changing the way that they reimburse providers, they are taking on a more hands-on role in patient-centered care. Cigna recently reported they would begin to offer coaching, medical management, and other care coordination services for Connecticut-based employers.

"[T]he role that we'll play is conveners: conveners of the stakeholders as we continue to evolve and continue to grow and adjust as we learn more amid technology changes,” said Cigna's North Texas and Oklahoma President LaMonte Thomas.

Blue Cross Blue Shield of Minnesota has partnered with Allina Health, 1 of the state's largest provider systems, to develop health plans tailored to consumer preferences. The insurance company has also begun working with Southern Prairie Community Care to better coordinate care for Medicaid beneficiaries.

"We are trying to move faster. We are piloting more. We are partnering more. We think—we know—that will help us transform healthcare going forward," said Michael Guyette, CEO at Blue Cross Blue Shield of Minnesota.

Payers can fill the gap in providers' ability to manage population health by providing them access to the data analytics they need to coordinate comprehensive care. A recent study from The American Journal of Managed Care found a predictive modeling tool from Aetna helped predict and target patients at risk for developing metabolic syndrome down to a specific risk factor. The findings are encouraging to insurers seeking to play a more active role in improving patient outcomes and costs, as much as it is for the use of predictive analytics in population health management.

“The ability of the models to produce highly individualized risk profiles for overall risk of metabolic syndrome and by specific risk factors allows for more successful patient engagement in subsequent care management programs,” said the study authors.

Around the Web

Doctor Pay Hits $232,000 As Quality Gains More Meaning In ACA Era [Forbes]

New Role for Payers: Drive Docs, Patients Together [Fierce Health Payer]