The adoption of a comprehensive collaboration model between consumers, providers and carriers will bring opportunity to an industry in search of a sustainable solution. Key to the success of this collaboration is a model that incorporates both a consumer-oriented product structure and a transformed operating model between carriers and providers. The model must establish a three-way partnership among all parties that will support the achievement of financial and health outcomes.

HealthScape believes that the risks of inaction far outweigh the risks associated with taking the action necessary to restructure key consumer, provider and carrier relationships:

COMPONENTS OF ACTION

  • Re-Orientation – Establish consumers as a key component of the model
  • Product Structure – The structure developed must drive consumer engagement in the model and create incentives for maintaining their health
  • Operating Model – Transform to focus on long-term partnerships between providers and carriers, supporting organizational design and integrated/ coordinated networks

RISK OF INACTION

  • Change in Coverage Dynamics –Employers abandon or delegate coverage to their employees in masses
  • Plan Design Change –Wide spread adoption of plan designs with greater consumer/employee cost shifting, creating revenue cycle and bad debt challenges for providers
  • Cut-Out the Middle Man – Substantive shift of employer coverage, bypassing carriers, going direct to large provider systems for service arrangements through enhanced risk relationships
  • Shift in Provider Dynamics –Slower moving providers losing patients and volume to competitors that participate in consumer-based, highly coordinated health coverage products
  • Market Consolidation –Increased consolidation as carriers and providers face financial struggles due to industry changes
  • New, Consumer-Focused Competitors – New market entrants restructuring health delivery to unique consumer segments including a highly mobile consumer-based model
  • Potential for Drastic Intervention – Government driven interventions that effectively create a single payer system by default

HealthScape’s proposed consumer-provider-carrier collaboration model presents a long-term solution to the current quality and cost quandary facing the industry. Carriers and providers can drive industry change in a manner that, over the long-term, will be favorable to all three parties that have made the commitment to the model. This executive briefing illustrates why we believe value-based reimbursement alone is just not enough.


HEALTHSCAPE CAN HELP.

If your organization is looking to formulate a value-based care strategy, HealthScape can help. Learn why value-based reimbursement alone is not enough. For more information, contact Alexis Levy at (312) 256-8671 or alevy@healthscape.com.