The U.S. Senate Committee on Health, Education, Labor and Pensions (HELP) is hosting a hearing today: Improving Quality, Lowering Costs: The Role of Health Care Delivery System Reform. America’s Health Insurance Plans (AHIP) submitted a statement for the record on health plans’ leadership in advancing delivery system reforms across the country. Below are some highlights from the statement:
- “Health plans are strongly committed to strengthening our nation’s health care system, and this commitment is evidenced by their partnerships with providers to implement new models of delivery and payment that seek to achieve the National Quality Strategy’s three aims of better care, healthy people/healthy communities, and affordable care.”
- “The private sector, and increasingly the public sector, has implemented a range of different models of care designed to achieve the nation’s goals of improving the quality and value of health care.”
- “Whether through electronic health records, patient registries, or an alternative HIT infrastructure, better use of data and HIT supports population health management, disease and case management, treatment decision support, and performance measurement – activities critical to improving patient outcomes at the point of care and identifying additional opportunities to bridge gaps in care.”
- “Over the past several years, health plans have partnered with hospitals and physicians to promote models that are transforming the delivery system by offering better care at lower cost. Plans have played critical roles in these initiatives by providing tools and data to support population-based care, providing programs and staff to better coordinate care, and structuring provider contracts to reward high quality performance and reductions in practice variation and cost.”
- “Some health plans have reported embedding nurse case managers in provider practices to assist with the delivery of care. Increasingly, health plans’ HIT infrastructure is enabling the two-way exchange of information, which supports efforts by case managers to coordinate care for patients with specific acute or chronic conditions across multiple providers and settings.”
- “…in addition to leveraging their HIT and data analytic capabilities and promoting patient centeredness through value-based insurance design, individualized care plans, and self-management tools, health plans are increasingly implementing new payment models in conjunction with efforts to redesign delivery.”
- “All of these payment models represent a movement away from fee-for-service to different degrees and a progression toward better alignment of incentives.”
- “While still in their relative infancy, these reform efforts have demonstrated a range of desirable results within specific plan-provider partnerships. These results include: reduced preventable hospital admissions and readmissions; reduced preventable emergency room visits; better patient outcomes; higher patient satisfaction; reduced practice variation; and better value.”
- “Just as past experience informs future action, existing and emerging models of delivery and payment reform have much to offer as we pursue meaningful change across the entire health care system.”
In case you missed it…
AHIP Article in Health Affairs Examines Private-Sector Accountable Care Models
A recent AHIP study that appears in the September edition of Health Affairs found that new health care delivery and payment models in the private sector are being shaped by active collaboration between health insurance plans and providers. The article found that not all providers are equally prepared to enter into accountable care arrangements and that flexibility and the technical assistance and support of health plans will be key to the success of these arrangements. The AHIP study identifies several important lessons that can inform how the final ACO rule is developed. Click here to read the full article in Health Affairs.
AHIP Summit on Shared Accountability
AHIP recently hosted a Summit on Shared Accountability that showcased a variety of innovative payment models that regional and national health plans have implemented across the country, such as ACO-contracting, patient-centered medical homes, and bundled payments. Health plans and their provider partners discussed key program features, lessons learned, and results that have been achieved in terms of higher quality care, better health outcomes, and lower health care costs.
