Cooperation between administrators, employers, providers and participants has always been important, but the continued implementation of health care reform and an increased focus on cost and quality of care make it a must.
The federal government is promoting accountable care organizations (ACOs) as a way to encourage a shift from volume-based reimbursement to a model based on quality and efficiency. Unlike volume-based reimbursement, which has encouraged the provision of more care, prepayment or capitation can force providers to focus on the bigger picture of improving health in order to avoid costly future claims and unnecessary care.
The Changing Primary Care Practice
To succeed in this changing environment, many physicians are reengineering their medical practices from traditional “physicians with support staff” to comprehensive “care teams” where medical assistants, nurses and even receptionists take on expanded roles in order to better coordinate patient care. Group practices that want to join ACOs will need to contribute to overall population health management. Rather than just providing preventive care, they will need to begin proactively reaching out to patients. With access to electronic medical records, they will need to track and monitor the health status of their entire patient population. It will be the only way to become accountable for the quality and cost of care.
Collaborating to Manage Health
When it comes to health management, self-funded employer groups are looking for a partner that can deliver a full spectrum of services, from plan design and claims administration to health care risk management, wellness and reporting. To help client employers adopt and implement successful population health management strategies, we continue to enhance our resources in disease management, wellness and data analytics.
By working together with employers, providers and other strategic partners, we can help assess the health of covered groups and reduce existing health risks. Programs can be implemented to care for those with chronic conditions. And with the right amount of teamwork in place, employees and dependents can begin to accept personal responsibility for the quality of their own health.
As we continue to move closer to full implementation of health care reform in 2014, this might be the time for you to consider adopting a multi-year approach to health management.
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In cooperation with NAEBA