美世Mercer-美国保险公司人力资源方案Human Resource Consulting.ppt

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * High Performance Networks Network models Limited Network A subset of an existing provider network comprised of high performing providers Tiered Network Employee copay/coinsurance differentials to encourage use of high performing providers Physician Partnering An arrangement with (typically) primary care physicians to enhance efficiency Consumer Driven Deployment of performance information to consumers to improve provider selection * Direct Contracting Large employers with significant market presence May be able to achieve significant savings by contracting directly with health care providers May need group of regional employers to achieve critical mass * Promote Consumer AccountabilityHelp patients be better consumers of health care Background If half of cost is due to lifestyle and half of chronic patients do not follow treatment plan, what can we do? Get members’ attention – make them aware of consequences Approaches to encourage consumer involvement include Coordinated health promotion, disease prevention and educational programs Tying employee cost increase to trend “Defined contribution” health plans Consumer directed health care Re-introduction of coinsurance * Efforts to Improve Quality of Care in Hospitals Leapfrog initiative The Leapfrog Group: Background Formed in response to Institute of Medicine study of errors in health care Goal: Major gains in patient safety, customer service and health care affordability Sponsored by Business Roundtable Employers in Leapfrog Group use purchasing power to encourage health care providers to adopt patient safety standards Leapfrog standards include: Computerized systems in hospitals to improve the accuracy of physicians’ prescriptions and minimize medication errors Staffing of intensive care units by physicians trained in critical care medicine Referral of patients requiring certain complex procedures to hospit