AHIP Statement On Payment & Delivery System Reforms

posted by Clare Krusing

on January 26, 2015

For Immediate Release

Washington, D.C. – America’s Health Insurance Plans (AHIP) President and CEO Karen Ignagni released the following statement in response to today’s announcement by the Department of Health and Human Services on payment reform goals for the Medicare program and creation of a new Health Care Learning and Action Network:

“Advancing a patient-centered health system requires a fundamental transformation in how we pay for and deliver care. Today’s announcement by Secretary Burwell is a major step forward in achieving that goal. Health plans have been on the forefront of implementing payment reforms in Medicare Advantage, Medicaid Managed Care, and in the commercial marketplace. We are excited to bring these experiences and innovations to this new collaboration.”

Over the next week, AHIP will highlight health plans’ innovative payment and delivery system reforms happening across the country. By partnering with providers and hospitals in new care coordination models, health plans are transcending the antiquated fee-for-service model and promoting patient-centered care delivery. For example:

  • One health plan in New Jersey and its local provider partnered on a new data sharing and payment initiative to more accurately identify gaps in patient care. By targeting high-risk patients and enrolling them in appropriate disease management programs, overall cost of care declined 13 percent in one year, and the program hit the 90th percentile for care quality.
  • For patients enrolled in another health plan’s accountable care model, which focused on strengthening care coordination among a patient’s specialists and hospital providers, individuals experienced better health outcomes and 3-7 percent decrease in the cost of care after being enrolled for more than one year.
  • In New York, one health plan’s patient-centered medical home strengthened its primary care support and structure with family doctors, which resulted in fewer ER visits, reduction in unnecessary use of antibiotics, and cost-savings of 14 percent for adults and 8 percent for children.

To learn more about new payment and care coordination models, click here. For updates on these innovations happening across the country, visit AHIP Coverage blog and join the conversation on Twitter with #morevaluebettercare


Providing Health Benefits for Over 200 Million Americans.

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