On the contrary, we believe that payers can achieve their full value only when they are deployed using an integrated approach. When I first joined The ThedaCare Center for Healthcare Value back in 2010, my first job was to help organize an assessment process to help our Healthcare Value Network member organizations understand their current state on their lean journey and help them move to the next level of maturity. having to deal with higher acuity patients combined with pressures Unfortunately, comprehensive network adequacy standards are missing in many states and many existing policies are outdated, having been developed years ago to regulate managed care networks (primarily Health Maintenance Organizations or HMOs).2Network adequacy standards can and should reflect important consumer protection principles that balance the goals of reduced costs and accessible, quality care, and apply these to all types of plans. 2023 Blue Cross Blue Shield Association. Furthermore, rural hospital networks help level the playing field by giving independent rural hospitals a single voice that facilitates conversations with commercial payers and urban health systems. These value networks, whether narrow or tiered, are used in over half of individual market offerings and are being rolled out extensively in Medicare Advantage. It has brought to light the lack of redundancy and diversity in pharma and medical supply sourcing and an urgent need for increasing digitization in the supply chain. Meaning is often innate to the individual professional. Medicare Fee-For-Service file, "43% of all national hospital The HVN is part of the ThedaCare Center for Healthcare Value and consists of a peer-to-peer learning community of approximately 60 healthcare organizations across the United States and Canada. Providers will continue to have little incentive to adopt downside-risk arrangements unless value-based payment either generates an opportunity to capture greater market share (through alignment with more restrictive networks) or poses a threat (exclusion from restrictive networks if they fail to accept downside risk). Additionally, if they do not, Cambridge, MA, June 8, 2010 - The Lean Enterprise Institute and the ThedaCare Center for Healthcare Value have formed the second Healthcare Value Leaders Network, building on the initial Network that started in June 2009. because the acute providers and payors have really only reduced the 2023 MultiPlan Corporation. the operations of post-acute providers and in particular, SNFs. Community-based-organization collaborations become even more important when developing value-based care capacity. McKinsey white paper. Today, one-in-three Americans are covered by the BCBS system. the Post-Acute Value Network can truly reduce Ron Present, Partner and National Association of Insurance Commissioners, "Network Adequacy," (April 18, 2019). many times, ineffective. In most cases, however, the potential rewards associated with these models are relatively modest; in only a small fraction of cases (we believe less than 20 percent in Medicare models, for instance) is there downside risk associated with underperformance.7LAN survey results estimate that one-eighth of all healthcare spending in 2017 was associated with downside risk models. Doing so could enable payers to better understand the barriers that hinder the impact of each approach, and to rethink how they might capture the full potential of each. Post-Acute Value Network. David Nuzum is a senior partner in the New York office. As a general rule of thumb, health plan provider networks must be large enough to deliver the benefits promised to the consumer under their plan. post-acute provider marketing and admissions personnel, emotions, All stakeholdersnot just healthcare providers but also drug and medical device manufacturers, distributors, and third-party logistics partnerscan now start leveraging digital supply chain networking technology and multienterprise work management tools to build a morepatient centric supply chain. All rights reserved. The answer, along with potential solutions, lie in understanding the health care value network. Subscribe to the Agile Supply Chain Insights Newsletter. Quality standards for the network should be well-defined, rigorous, and derived from sufficient data in order to drive performance delivering quality outcomes and making a substantial impact on healthcare spend. by Clint MacKinney, MD, MS; Nate White, JD; and Brett Norell, MHA, MPH. Greater alignment of these strategies can allow payers to unlock their transformative potential. 8. The PHCS Network for VDHPs delivers the optimal balance between the network access consumers want and the medical cost savings the health plan expects. increasingly being adopted by acute providers and payors is the Failure to meet this standard could violate anti-trust laws if the network were to attempt single-signature contracting with payers. Cooperative education, experience, improvement, and collegiality can all blossom in a CIN. A value network allows. Network will, by design, reduce the number of SNFs the hospital In practice, strategic and regulatory considerations (e.g., network adequacy) may require occasional deviations from integrated deployment. Jennifer Atkins is vice president, network solutions for the Blue Cross Blue Shield Association (BCBSA), a national federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield (BCBS) companies. To print this article, all you need is to be registered or login on Mondaq.com. Dutch hospitals make value-based health care work. average, Managed Medicare plans reimburse nursing home operators October 2016. Volume-based payment fee-for-service and cost-based reimbursement, for example is giving way to value-based payment such as shared savings and global budgets. managed plans are also usually more aggressive about controlling MultiPlan recently introduced its new PHCS Network for Value-Driven Health Plans (VDHPs). The volume-to-value transition is underway in U.S. health care. Would you simply hire the candidate willing to work for you at the lowest rate? The seven characteristics of successful alternative payment models. Robust data-sharing and effective quality measurement play a critical role, as well, in identifying providers delivering quality care at a lower cost. The network includes practitioners and select ancillary services providers such as labs, home health and clinics and is exclusive to HST clients. Disclosure Your trust is important to us. By Karthik Narain | February 1, 2023. As of 11/21 . the current management and care of post-acute patients creating Some care needs can be met throughtelemedicine. The authors of this article are helping establish the Rough Rider High Value Network (RRHVN) a network of 23 independent rural hospitals in North Dakota with a service area of nearly 250,000 people. How to choose health care coverage See if your business is eligible It has shown healthcare organizations how important coordination and collaboration are in the healthcare value chain. January 2019. As health care costs continue to rise, with some predicting significant increases in 2024/2025, large employers are continuing to consider and adopt high-performance network (HPN) designs that steer employees to higher-quality, cost-efficient providers while limiting or eliminating coverage for low-quality providers. Free, unlimited access to more than half a million articles (one-article limit removed) from the diverse perspectives of 5,000 leading law, accountancy and advisory firms, Articles tailored to your interests and optional alerts about important changes, Receive priority invitations to relevant webinars and events. As private health plans pursuenarrow networksto rein in premium increases, specifying and enforcing this standard becomes particularly important. majority of patients historically. UL is also a sponsor of the Healthcare Value Network, a consortium of healthcare providers committed to providing high-quality, cost-effective care through the application of lean concepts. The same is true for value-based payment models with both upside and downside risk (whether bundled payments, total-cost-of-care risk sharing, and/or capitation). In our experience, providers (hospital systems in particular) are apt to accept financial risk only if it is directly tied to the negotiation of the network contract, with the negotiation having the same consequences for network participation as other terms and conditions.10We include in the definition of financial risk those situations in which a provider accepts a lower-than-desired fee schedule coupled with an upside-only opportunity to earn additional rewards based on savings generated for the payer or plan sponsor. The RRHVN mission is to create and advance the RRHVN a sustainable network of rural North Dakota Critical Access Hospitals and clinics that increases clinical quality, pools member resources, manages financial risk, and improves community health. The RRHVN has established 10 guiding principles. By facilitating seamless information flows, the digital network platform enables organizations to leverage analytics more broadly, using real-time data from across the supply chain to identify and eliminate bottlenecks early, minimize the impact of upstream disruption, and proactively prevent shortages or delays in the delivery of medications and medical supplies. instability of a fragmented post-acute market, reduce cost through development and utilization of a post-acute preferred or Narrow threat has prompted some post-acute providers, in particular A clinically integrated network (CIN) is a group of like-minded healthcare organizations and clinicians who agree on a set of quality improvement (better care) and efficiency improvement (smarter spending) strategies and then hold themselves accountable for delivering those strategies. patient preference), Skill set (services, staffing, In recent years, they have returned to a strategy from the 1990s: creating more limited provider networks to shift patient volume to more cost-efficient providers and, in some cases, secure additional fee-schedule concessions. The terms "value chain" and "supply chain" are often used interchangeably to refer to the chain or network of entitiesmaterials suppliers, manufacturers, distributors, and retailersthat provides consumers with products, starting with the input of raw materials through production, packaging, and distribution and to the point of consumption. Is there a proven track record of success? Furthermore,a nationally representative surveyshows that when consumers experience a problem related to inadequate networks, they do not know where to complain. Targeting' cookies are linked to services provided by third parties, such as 'Like' buttons and 'Share' buttons. Such a structure allows for value-based payment to become a tool for overcoming an impasse in a fee-for-service contract negotiation, since it creates real skin in the game for the provider while also limiting its total exposure. They need technology that fosters knowledge sharing and collaborative endeavors and enables trading partners to work together to drive tangible value for their organizations and the health systems and patients they serve. Catholic Health Initiatives, the Cleveland Clinic and the Henry One strategy for the value-based service delivery method However, CINs can be the vehicle to develop professional mastery and membership. Exhibit 2 illustrates what a value-based assessment of networks and providers might look like in a dashboard format. 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US health insurers have attempted to use network and payment levers in multiple ways to reduce medical costs. For example, we use these Strictly Necessary cookies to identify you as being logged in to the Site. Let's connect and explore what we can do for you. Skip to main content Insurance Plans Medicare and Medicaid plans Medicare For people 65+ or those under 65 who qualify due to a disability or special situation Medicaid Jessica Lamb is a partner in the Philadelphia office. Polsky, Daniel, Janet Weiner and Yuehan Zhang, "Narrow Networks on the Individual Marketplace in 2017," University of Pennsylvania Leonard Davis Institute of Health Economics, Philadelphia, P.A. cost, improve care and enhance the patient's experience. Measuring Progress: Adoption of Alternative Payment Models in Commercial, Medicaid, Medicare Advantage, and Fee-for-Service Medicare Programs.
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