The health care industry is experiencing a significant shift in the relationship between insurance companies and health care providers, with many 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 lower costs.
Recently, a group of the nation’s largest health care organizations and insurers announced they would collaborate through a new organization, the Health Care Transformation Task Force, with the goal of shifting 75 percent of their business to contracts with value-based payment arrangements that hold providers accountable for the cost and quality of care. In addition, federal health officials recently announced a plan to transition half of 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 the quality of care and efforts to control costs.
These new 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, helping to control medical costs in the long run.
There are established goals to ensure this new payment model takes hold. The U.S. Department of Health and Human Services secretary 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 this year. In addition, the federal 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.
There already is success implementing this plan. According to an independent review of Medicare payments by nonprofit Catalyst for Payment Reform, 42 percent of health care dollars Medicare paid to providers in its fee-for-service program in 2013 were targeted to increase patients’ quality of care.
Southern Nevada also is experiencing this trend of health care providers and insurance companies joining forces to promote better care. DaVita HealthCare Partners, one of the nation’s largest health care organizations, announced its partnership with insurance company Humana to create a new special-needs plan for Medicare beneficiaries with end-stage renal disease in Las Vegas: Humana Kidney Care. For more information about it, visit humana-medicare.com.
Rick Beavin is Nevada president for Humana’s Senior Products and Dr. Ama Brobbey is chief medical officer for HealthCare Partners Nevada.