The health care landscape is rapidly changing as employers, patients and health care providers look for ways to contain rising costs. But you don’t have to understand every part of this complex industry to bring about change.
Offering a health plan for your employees is a vote of confidence in that plan’s network, coverage and overall ability to improve your workforce’s access to affordable health care. Small business owners can further health care innovation by carefully assessing which plans will bring the most benefit — and the most value — to their employees.
What Is Value-Based Care?
For decades, the health care industry operated on a fee-for-service payment structure. If you received a service, your doctor or hospital was paid for that service, even if it wasn’t clinically necessary or didn’t end up improving your health.
The value-based care model, on the other hand, aims to tie how patients pay for care to how effective that care is — in other words, how much value it brings. Value-based care has already been shown to reduce emergency department visits and inpatient hospitalizations, and it has led to improved preventive care and chronic disease management.
What Role Do Employers Play?
Nearly 50 percent of insured Americans get their insurance through their employers. The success of your business relies on your ability to attract and retain the best talent, which often means providing an appealing benefits package. But offering competitive benefits without straining your budget isn’t always easy.
In order to properly assess health care costs, employers should understand what tools are available to control them. When choosing a health plan, look for one that includes the three pillars of value:
- High-performance networks. High-performance networks drive employees toward doctors and facilities that have demonstrated that they provide top-quality care while containing costs. Your insurance company may be able to help you pull together data to find the doctors in your geographic area that offer the best outcomes with a focus on the cost of care. You should check that your network is broad enough to include access to preferred doctors and a range of specialists, or your employees may be forced to go outside of the network.
- Value-based payment models. Unneeded tests, repeat hospital admissions and poorly managed chronic diseases are just some of the drivers of high health care costs. Accountability-based payment models consider the entire cost of an episode of care, even when multiple providers are involved. Some alternative methods of care, such as accountable care organizations (ACOs), institute value-based payment models across their network of providers. Not only do ACOs seek to reduce costs, but they’re also coordinated across the entire spectrum of care, from checkups to specialist visits, making it easier for patient information to get to the providers who need it.
- Smart benefits design with a focus on wellness. Choose health plans and benefits packages that provide the most value for employees through networks with access to high-quality providers and a focus on wellness. Chronic conditions like diabetes and heart disease can be incredibly expensive, but in many cases they can be managed or avoided altogether. Providing benefits packages that promote and reward healthy lifestyle choices improve employees’ health and reduce the need for medical services.
How Can Employers Find the Best Health Plan Solution?
Many health plans tackle at least one of the pillars, but bringing them all together will give your business the best chance of delivering value in your employees’ health care.
Anthem’s Cooperative Care pilot program, for example, helps employers in certain states control health care costs by rolling all three pillars into one plan. With the program, employees choose a primary care provider to act as their hub for medical services and use an ACO within a high-performance network. Specialists and other providers within the network are held accountable for the overall service they provide, with value-based payment models that reward providers for high-value/low-cost services and improved outcomes. Employees receive a health plan designed to furnish them with coordinated care, a deeper patient-provider relationship and better health outcomes with an emphasis on overall wellness. Anthem’s Cooperative Care program offers a special focus on the patient experience, with shorter wait times, lower costs and quality doctors all leading toward the goal of better health.
Employers are poised to be a major force in the value-based care transformation happening across the health care industry. In choosing a plan for your employees, you’re making a claim about what you want the next health care innovation to look like — for your workforce and for yourself.
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