The Next Generation of Value Based Medicine: Corporate Population Health Management™ – Part 3: “Working Together"

At the end of Part 2, we left with the question, “how do the corporation and provider community team up to increase the Health Assets™ of the company?"  The most common question I get asked is on this topic is why aren’t the insurance companies solving this problem?
 
Here are a few reasons:

1. Insurance companies are caught in the middle. They actually have two customers, the corporations and the providers. They can’t alienate either, which means that eliminating or restricting providers can compromise their provider panel and decrease their attractiveness to corporations during an era of “we want to be inclusive” demands by corporations.
 
2. With the Affordable Care Act, they have to continually update every policy and re-educate their corporate customers about numerous changes, which is a time consuming and expensive undertaking.
 
3. They are in the process of converting to make major changes, such as ICD-10 (medical classification list by the World Health Organization for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases) that require extensive redesign and reprogramming of their systems.
 
4. They continually find themselves in the position of being bid against each other, and often replaced; having to start again with corporations every two to five years.
 
So, between claims adjudication and network management, on top of the continually changing and evolving health care environment, they have their hands full!  Thus it will require the employers and the providers of care to find additional, effective ways to work together.
 
One opportunity for this is Open Health Market, which links the employer and providers to ensure that employees get the right care, from the right provider, at the right place, and for the right cost. This tool allows the corporation to say to the medical community “this is what we, the corporation, want for our employees.”  By putting these requirements into the marketplace, the population-based medical providers in their community have the opportunity to say “we feel the same way, we want to provide that for you”.  Employers start to identify and partner with like-minded providers in their community who support them in getting a higher return on their Health Equity Investment™.
 
Couple these efforts with plan design or “soft steerage” through care coordinators and ACAP’s transparency tools; and in a relatively short period of time, you move the employees of the company to the highest quality providers, resulting in higher morale, more convenient care, lower cost, and longer, healthier lives.