
Insurers Embrace More Active Role in Value-Based Care
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.
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
“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,”
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,"
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
“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.
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