美国保险业协会绝密HR分析报告(英文).pptVIP

What is a HPN?  High Performance Network: A health plan performance improvement method that steers care to providers that meet specific efficiency and quality criteria * Rationale for HPNs  New management approaches are needed in this era of cost acceleration Patients and physicians are the key drivers of health care costs But they have limited or no incentive to care about costs The heart of the High Performance Network concept is to change the provider selection behavior of patients and/or physicians * 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 Emplo