By Melina Kambitsi Ph.D.
SVP, Business Development & Strategic Marketing

A small group of empowered purchasers can change the entire health delivery system by demanding more value, which is becoming ever important given the rate of physician and hospital consolidations.

Research studies show that when larger systems buy up smaller independent providers, it drives up the price of health care for employers.
As employers, we have the power to demand better health care affordability, we just need to use it. The Alliance acts as that voice by using the Four Core Drivers of High-Value Health Care.

The fourth and final Ð Benefit Plan Design accomplishes two things:

  • It makes the right care more convenient, accessible, and transparent to employees, making it more likely that enrollees choose cost-effective and high-quality health care; and
  • It provides financial incentives for employees and their families to choose high-value health care that delivers better results for lower costs.
    Benefit plan design is the driver that brings all the components of high-value health care together: Transparency, Payment Reform, and Provider Net­work Design

Examples of Strategic Benefit Plan Design
Financial incentives that reward enrollees for choosing higher-value health care are probably the most common benefit design strategy that employers utilize today. Network leveling (or tiering) is an example of this, where high-value health care providers are more affordable for plan participants. Providers who don’t want to be in lower levels are driven to change their business model, usually by lowering their prices.

Employers are also using benefit plan design to help employees get the right care. Roughly 33% of employers today are increasing out-of-pocket costs for services that are overused or potentially inappropriate without an evidence-based approach. Others are lowering out-of-pocket costs for services that employees need to stay healthy, like diabetic supplies.
Yet another strategy is offering High-Value Primary Care through on-site or shared-site clinics at low or no cost.These providers can then help educate employees and refer care to high-value specialists.

What can Employers Do?
Employers can use tools The Alliance has developed to create benefit plans that make high-value health care accessible and less expensive for their employees. Because when enough employers get involved and provide these kinds of incentives, physicians will be motivated to improve the value of their care and make real change in the market.

To start strategizing your own health benefit plan design, including opening a clinic, please reach out to us today or email

Melina Kambitsi

Melina Kambitsi

Melina Kambitsi joined The Alliance in 2017 and leads the teams responsible for business development, client development and strategic marketing.

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