The Role Of Payors In Catalyzing New Care Models For High-Risk Patients

posted by Vively Health

on March 11, 2019


Managing high-risk, medically complex patients poses a challenge for providers, health
systems and insurers alike. Patients with multiple chronic conditions require a high-touch,
tailored care model, but the size of the population—less than 5 percent of all patients—
is typically not large enough for any one provider, group or health system to justify the
significant investments required to manage them appropriately.

Payors, however, have a unique opportunity to leverage the scale they have across a
geographic area and align incentives for new entrants to create the necessary care models,
driving quality and cost improvements for their entire market.

So what is the role of payors in addressing this challenging issue? How should the care
model be designed? What are the financial implications?

This white paper covers the unique characteristics of medically complex patients and the
specific capabilities required to manage their conditions. By delving into proven care and
financial models, it will help provide the context necessary for payors and risk-bearing
organizations to respond to the above questions and, ultimately, to make an informed
decision about how to move forward in support of new care models and new entrants for
high-risk, high-cost patients.

This [presentation/paper/etc.] represents the views of the author, not America’s Health Insurance Plans (AHIP). The publication, distribution or posting of this [presentation/paper/etc.] by AHIP does not constitute a guaranty of any product or service by AHIP.