March 18, 2021
Value-based
care is continuously evolving and Premera continues to work with local
providers who are committed to delivering high-quality, cost efficient care for
our customers. These relationships are built on trust, shared data, and
analytics with the common goal of decreasing the total cost of care, improving
customer experience and health outcomes.
“Value-based
healthcare rewards our providers for what matters most: improved health
outcomes for their patients,” explains Dr. Susanne Quistgaard, Medical Director
at Premera.
At
Premera, we’re always looking for new and innovative ways to deepen our
relationship with providers through value-based care. We work within the Health
Care Payment Learning & Action Network Alternative Payment Model (APM) framework
and are moving further down the continuum of APM categories toward
risk-sharing, as well as replacing fee-for-service payments.
Examples include:
- Bundles Following the Bree Collaborative
recommendations, our bundles include pre-surgical and post-services,
accountability for quality (outcomes) and patient experience, and a warranty --
all at a competitive cost. Current bundles include total hip/knee replacement,
spine surgeries, and gynecological procedures.
- Employer-based ACOs—Collaborating
with key employers to focus on a specific region, we partner with key providers
to develop ACOs with an enhanced member experience, improving quality outcomes
and providing cost effective care.
- Risk models—Having the
foundation of our well-established, trend-based shared savings model, Premera
is working with providers to significantly expand their membership base while
taking on regional risk. These risk models further align incentives to a
patient-centric model that better serves our members.
The
variety of these models is exciting, inspiring, and points to the fact that by
working together we can improve customers’ lives.
This article is the second part of a series
dedicated to understanding value-based healthcare. Read the first article, Payment Models Shift to Value-Based Care.