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Top 4 Ways Payers Could Improve Patient Health Outcomes

Health insurance companies are following a few key ways to improve patient health outcomes and reduce spending.

Health Information Technology

Source: Thinkstock

By Vera Gruessner

Health insurance companies have been putting more focus on preventive care, a reduction in unnecessary medical testing, and better patient health outcomes by transitioning to value-based care reimbursement. National payers have utilized a number of steps to improve patient health outcomes in an effort to reduce rising medical spending. The top four ways are outlined below.

Adopt health information technology

Healthcare payers could protect patient safety and prevent medical errors by implementing health information technology. Payers could incentivize providers financially for adopting electronic medical records and e-prescribing systems. Additionally, health information exchange systems could play a role in strengthening care coordination and improving patient health outcomes.

Health information exchange and electronic records could enable physicians to better track a patient’s health status and monitor the quality of healthcare delivery, according to the Journal of the American Medical Association.

Health information technology enables payers and providers to work together to eliminate gaps in care and aggregate patient population data. For instance, health information exchange could help public health agencies track which regions are more likely to have patients admitted to hospitals or clinics for suffering asthma attacks. This would enable public health agencies to work on improving primary care access in certain regions and determine if any environmental factors contribute to health issues.

READ MORE: Top Challenges of Alternative Payment Models, Bundled Payments

Transition to alternative payment models

The traditional fee-for-service payment system has led to a constant rise in healthcare spending without as much value put toward improving patient health outcomes. In order to put a dent in continually rising medical costs and boost quality of care, more and more health insurers have been transitioning to value-based alternative payment models.

Last summer, the national payer UnitedHealthcare announced that it had awarded 1,900 medical facilities with the 2015 UnitedHealthcare PATH Excellence in Patient Service Awards since these providers were able to improve patient health outcomes among Medicare Advantage beneficiaries. UnitedHealthcare spent $148 million in bonus payments to organizations that had reduced their total spending and met performance metrics in the value-based care program.

The value-based financial incentive system from UnitedHealthcare has improved patient health outcomes by focusing on preventive care and the monitoring of serious and chronic medical conditions.

Create partnerships and share data

READ MORE: Health Information Technology Allows Payers to Share Data

Another solid way that payers could ensure patient health outcomes are enhanced is to partner with like-minded organizations and share pertinent clinical or claims data in a timely manner. For example, in December 2016, the payer Aetna announced that it had partnered with the National Center for Complex Health and Social Needs to improve outcomes among those patients that seek the most medical services.

“Our vision is to make Camden the first city in the country to ‘bend the cost curve’ while improving quality,” stated Jeffery Brenner, MD, the Executive Director of the Camden Coalition, which will be undertaking the services offered through this partnership. “Using this grant, we can not only expand our ability to share our learnings among healthcare providers, but also support the development of similar models that will truly improve the health of communities and neighborhoods across the country.”

This partnership looks to promote the sharing and integration of cross-sector data across healthcare facilities. Sharing medical data quickly and effectively is expected to improve patient health outcomes on both a physical and mental health basis.

“We know that cities and counties have the power to create a long-term positive health impact throughout their communities by addressing social determinants of health,” said Garth Graham, MD, MPH, President of the Aetna Foundation. “Dr. Brenner’s approach has improved the health of the residents of Camden, and we will work collaboratively with the National Center for Complex Health and Social Needs to expand this model for improving care for patients with significant health care needs.”

Implement preventive care strategies

READ MORE: How Accountable Care Organizations Use Preventive Services

As health insurance companies continue to strive to reach the Triple Aim of Healthcare, many payers and providers are finding that a greater focus on preventive care may lead to better patient health outcomes. For instance, primary care providers could engage patients with chronic conditions to receive preventive care and screenings in order to avoid more costly emergency room visits.

One example of adopting preventive care strategies comes from Harvard Pilgrim. The payer awarded $202,950 in grants to 22 nonprofit organizations in New England as part of the ‘Healthy Food for Every Age’ program. The funds will be used to teach aging adults how to eat healthier and enable them to participate in cooking and nutrition classes as well as gardening activities.

Health insurance companies looking to reduce medical costs, improve patient health outcomes, and ensure high member satisfaction should consider following the steps above.


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