The health care industry is experiencing a shift in the relationship between insurance companies and health care providers, with many large-scale providers and insurance companies joining forces to provide patients with improved levels of care. This often includes partnerships to create new payment models with incentives to promote better quality of care at a lower cost.
Recently, some of the nation’s largest health care organizations and insurers announced they would collaborate through the new Health Care Transformation Task Force, with the goal to shift 75 percent of their business to contracts with value-based payment arrangements that hold providers accountable for cost and quality of care. In addition, federal health officials announced a plan to transition half of the Medicare spending that isn’t devoted to managed care into accountable care, bundled payments and other contracts offering rewards and penalties for providers based on quality of care and efforts to control costs.
These payment models reflect an increasing departure from the health care industry’s traditional fee-for-service model, which offered medical providers financial incentives for the volume of patients treated rather than the quality of patient outcomes. By rewarding comprehensive care that results in improved health, medical organizations are working to prevent further health issues down the road, helping to control medical costs in the long run.
There are goals to ensure this new payment model takes hold. The U.S. Department of Health and Human Services secretary recently announced a goal to tie 85 percent of fee-for-service Medicare payments to quality or value through alternative payment models by the end of 2016. The government aims to tie 90 percent of payments to these models by the end of 2018. It’s the first time the U.S. government has established set goals for alternative payment models and value-based payments.
The plan has already shown it can be successful. According to an independent review of Medicare payments by nonprofit Catalyst for Payment Reform, 42 percent of the health care dollars Medicare paid in its fee-for-service program in 2013 were targeted to increase patients’ quality of care.
Southern Nevada is part of the trend. DaVita HealthCare Partners, one of the nation’s largest health care organizations, recently announced a partnership with insurance company Humana to create a special-needs plan for Medicare beneficiaries with end-stage renal disease.
Called Humana Kidney Care, the local plan involves partnerships between Humana, medical network HealthCare Partners Nevada and VillageHealth, the integrated kidney care division of DaVita HealthCare Partners. The goal is to provide patients with coverage for comprehensive care, treating all aspects of their complex condition.
Rick Beavin is Nevada president for Humana’s senior products and Dr. Ama Brobbey is chief medical officer at HealthCare Partners Nevada.