BI’s Article search uses Boolean search capabilities. If you are not familiar with these principles, here are some quick tips.

To search specifically for more than one word, put the search term in quotation marks. For example, “workers compensation”. This will limit your search to that combination of words.

To search for a combination of terms, use quotations and the & symbol. For example, “hurricane” & “loss”.

Login Register Subscribe

Innovative new coalitions encourage high-quality patient care at optimal value


CHICAGO —In a bid to ensure that health care is affordable and high-quality, key stakeholders are changing the way they do business.

“The ACA and advancement in technology have allowed all of the stakeholders within an entire health care delivery system to explore and try to understand better the issues, and flaws, and concerns with the existing health care delivery system and figure out ways to evolve and develop and shape new approaches to health care delivery,” said Dr. Bruce Sherman, medical director of population health management at Xerox HR Services in Cleveland.

Health care providers, insurers and employers are moving toward a system that delivers and pays for value, Mr. Sherman said.

Specifically, “there has been a broader focus on outcomes- and value-based contracting — innovative contracting models to try to more effectively align service delivery with payment,” he said last week during the Midwest Business Group on Health's 36th annual conference in Chicago.

For employers, such value-based strategies may include contracting with a health plan for services at a center of excellence; implementing high-value, narrow networks; or directly contracting with medical providers, centers of excellence or accountable care organizations.

According to a November survey by the National Business Group on Health and what was then Towers Watson & Co., 37% of employers contracted with a health plan for services at a center of excellence last year while another 25% plan to do so this year or next.

Eleven percent of employers surveyed implemented high-performance or narrow networks in 2015, but 8% more were planning to this year and 42% were considering it for 2017.

Employers can focus on value-based care by changing plan design, Dr. Sherman said.

Employers can make high-value services or screening and prevention essentially free, and focus on “cost-sharing on those services that are of questionable value,” John Rother, president and CEO of the Washington-based National Coalition on Health Care, said during an interview. “You are trying to change behavior. It's the recognition that some elements of health care are much higher value than others and that the benefit should recognize that.”

John Neuberger, director of client partnerships at Sussex, Wisconsin-based Quad Graphics Inc., said the printing firm that has 24,000 employees has implemented a value-based design for conditions that include diabetes, asthma and hypertension.

Patients that qualify and opt into the program get generic medications and supplies free, “which is a big deal for diabetics because that's almost $500 to $600 a year,” he said during a panel discussion.

“We see minimum compliance improving, and the number of diabetics in the program continues to grow,” Mr. Neuberger said.

Additionally, Illinois-based health system Advocate Health Care and health insurer Aetna Inc. are moving toward a value-based system.

“We created an incentive model that rewards our physicians based on results and their performance. Those results are tied to clinical outcomes,” said Bill Santulli, executive vice president and chief operating officer of Advocate Health Care.

“The incentives range from complying with our orthopedic implant standards to managing chronic diseases, such as making sure that diabetic populations are within the proper range managing their hemoglobin a1c,” he said.

Hartford, Connecticut based Aetna, which has more than 800 contracts for value-based reimbursement, aims to have 75% of its medical expenses “running through a value-based contract” by 2020, said Tammie Lindquist, vice president of accountable care solutions enablement services with Aetna. Forty percent of the insurer's medical expenses are related to value-based contracts now, she said.

“Our strategy is really focused on a continuum of value-based contracting models, meeting the provider where they are at in terms of readiness to accept risk, where they're able to focus on quality, efficiency and the total cost of medical care, or episodic medical costs,” she said.