Employer strategies to reduce health costs and improve quality through network configuration.
The High-Performance Network Work Group of the American Academy of Actuaries Health Care Delivery Committee developed this white paper to provide an examination of the development and measurement of high-performance networks and organizations, integrated financial arrangements, reimbursement methods, benefit designs, and stakeholder collaboration for financially successful performance networks and health programs designed around them.
The future of US healthcare is the Integrated Health Network (IHN 3.0) that will act as both a curator and guarantor of health and well-being for everyone.
Investigation into care coordination definitions, practices, and interventions has recently been sponsored by several national organizations including the Agency for Healthcare Research and Quality (AHRQ), the Institute of Medicine, and the American College of Physicians, among others. While evidence is starting to build about the mechanisms by which care coordination contributes to patient-centered high-value, high-quality care, the health care community is currently struggling to determine how to measure the extent to which this vital activity is or is not occurring.
Patient-Centered Medical Homes are driving some of the most important reforms in healthcare delivery today. A growing body of scientific evidence shows that PCMHs are saving money by reducing hospital and emergency department visits, mitigating health disparities, and improving patient outcomes. The evidence we present here outlines how the medical home inspires quality in care, cultivates more engaging patient relationships, and captures savings through expanded access and delivery options that align patient preferences with payer and provider capabilities. This report will be updated as new evidence of PCMH implementation is released. The National Committee for Quality Assurance (NCQA) exists to improve the quality of health care.
We observed positive cost-related and utilization-related effects from the introduction of a DPC option in the employer’s self-insured health benefits plan. About half of the members included in our analysis enrolled in the DPC option, and the DPC option was associated with a statistically significant reduction in overall demand for health care services (−12.64%) and emergency department usage (−40.51%) after controlling for differences in age, gender and health status between the DPC and traditional cohorts. The DPC option was also associated with a lower inpatient hospital admission rate (−19.90%), but the difference was not statistically significant due to the small number of admissions during the two years analyzed. However, we also estimated that the introduction of a DPC option increased total non-administrative plan costs for the employer by 1.3% after consideration of the DPC membership fee and other plan design changes for members enrolled in the DPC option.