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The 3 Pillars Of Paying For Value

by AHIP

October 3, 2018

Adapted from an AHIP Institute presentation by Dr. Mark Mugiishi, Chief Health Officer & Chief Medical Officer at HMSA; and Dr. Stuart B. Baker, Executive Officer & President Emeritus at Navvis

Many health insurance providers are focused on transforming the fee-for-service model to put their patients at the center of the health care system, and to incentivize care quality over quantity. But what does that mean in practice? Here’s how technology can build a connected system of care and health for patients.

  1. Align Incentives. To meaningfully transform the health care system, incentives must be aligned with better health, not the number of services provided. Insurance providers should focus on meaningful access, quality, and cost metrics to accurately measure impact, and use data to inform decision making.
  2. Integrate the Delivery System. Deploying a comprehensive care model means providing a holistic, connected, accessible health care ecosystem and community services for care of the whole person: including prevention, acute care, chronic disease management, and advanced care.
  3. Engage Stakeholders. Supporting doctor and provider organizations requires building a strong connection through physician leadership development, collaboration, and training, as well as employing consistent change management processes and planning. Empowering consumers, enhancing the customer experience, and engaging employers also should take priority.