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This week’s guest post comes from Dean Farley PhD, Vice President at OptumInsight. An advocate for collaboration across all constituencies for better patient care, here he explains how payers and providers can make bundled payments a reality.
The idea of implementing bundled payments can be intimidating for any hospital CFO. But, as a way of paying providers that combines all the services needed to treat a patient, bundled payments are an inevitable step for both payers and providers as the industry heads toward accountable care.
The rise of various accountable or collaborative care models across the country is already driving new demand for the right technologies to support them. These technologies are especially critical for those aiming to achieve Sustainable Health Communities, where all parties are connected, intelligent and aligned. While hospitals and health networks are already familiar with electronic medical records (EMRs) and health information exchanges (HIEs), they will need to become comfortable with a group of new solutions — some that the payer community has relied on for years and others that will put the data from EMRs and HIEs to the test.
What a difference a year makes! I am amazed how mindsets are changing in an industry that typically takes its sweet time to make any changes of significance.
In a sense, the whole debate around healthcare reform — both before and after it was enacted — shocked those who were not happy with the proposed models into starting their own initiatives around new models of care. We have entered a new era of collaborative care and provider transformation and, whether you believe in state-sponsored health insurance exchanges and ACO’s or not, one fact holds true: the lines between payer and provider are becoming blurred. Take the recent controlling interest that Pittsburgh insurer Highmark Inc. took in West Penn Allegheny Health System as an example. Hospitals, which are the core of this new wave of accountable, integrated care, are moving to models where they will take on more risk, and they are in dire need of new expertise and tools to help them manage populations rather than care episodes. This is something that payers have done for over 50 years, and they are now jumping in to help hospitals get there.
As the discussion of Sustainable Health Communities continues, we welcome to Healthcare-Exchange Joel Hoffman, Senior Vice President with OptumInsight Consulting, who sheds light on the payer perspective.
Football season may be over for the year. But for payers, the idea that “as goes the quarterback so goes the team” has never resonated as loudly as it does now — and will in the future — in the new world of Sustainable Health Communities.
Historically, payers have had an important, yet somewhat fundamental role: to select and manage risk, to negotiate favorable provider contracts, ensure its network is comprehensive, design appropriate benefit plans, manage care and provide appropriate customer service. Now, as we enter the era of Sustainable Health Communities, payers take on a new and even more critical function as the enabler — the head coach of the team where the primary care physician (PCP) is the “quarterback” in the local health care delivery system.
This week, Bill Miller – OptumInsight EVP responsible for provider strategy and solutions – explains why Sustainable Health Communities are both possible and probable in the years ahead as guest blogger for Healthcare-Exchange.
The buzzword du jour in healthcare is “Accountable Care Organizations”, or ACOs. The cynics among us might ask “Weren’t we calling these ‘medical homes’ just a few short months ago?” Those with long memories in addition to that dose of cynicism hark back twenty years and say these are just capitated HMOs.
The term is hardly what’s most important as the healthcare system evolves in response to healthcare reform, ARRA meaningful use, spending cuts, increasing regulation and a myriad of other influences, many of which are beyond the control of the hospital community. What matters is the outcome, the building and operation of what we at Ingenix refer to as Sustainable Health Communities.
