Health benefit plan and associated provider network design are foundational to meeting plan sponsor objectives. Here are two key health plan and network design considerations for employers and payers/administrators as they shift to increasingly value based and consumer directed healthcare plans for their employees and members. Let’s define “value” as the buyer’s definition of performance
Traditional health plan designs and operational approaches created to reimburse network providers at varying negotiated levels based on activity are no longer sufficient and may soon be outmoded. They are evolving to accommodate new value based concepts of what it means to perform and provide value to plan sponsors, employees, and their plan administrators. Read
In our last post we looked at four key threats to payers from industry devolution with value based reimbursement. These included: Administrative Service Disintermediation Network Management Disintermediation Health Management Disintermediation Loss of Negotiating Leverage Each threat is largely a result of the consolidation of provider organizations of all types into multi-modal comprehensive integrated delivery systems.
In previous posts we’ve discussed the impact on providers of the industry’s transition to value based reimbursement concurrent with the devolution of healthcare providers, settings, and technology. But our payer and third party administrator (TPA) clients are also facing significant risks and challenges from these changes in industry structure and dynamics. Just as with providers
For some time now we’ve been briefing our clients on the impacts of the healthcare industry’s transition to value based reimbursement. The conversation quickly moves into the added complexity of this transition occurring concurrently with devolution of the healthcare ecosystem. Payers and providers of all types, and those supplying the industry with products and services