Rewarding providers for high-quality care isn’t simple. Health care providers aren’t viewed as service providers because health care is more than a business transac­tion, and traditionally, 100% of the risk has been on purchasers. This means that employers, as purchasers, have paid for waste and mistakes, even when the health care provider is at fault. This long-established history makes payment reform com­plicated but necessary.

Incentivizing Quality Care

Achieving payment reform by creat­ing the right incentives for care deliv­ery is the foundation of The Alliance.

We’ve used our strength in num­bers to pursue unique contract pro­visions that protect our members and their employees from unexpect­ed charges.

We’re building on that foundation to include a fo­cus on cost and quality transparency (our first core driver) to continue the payment evolution.

Payment Reform In Action

Now, we are implementing con­tracts that use Medicare-based pricing. Medicare, the largest pur­chaser of health care in the US, has done the work to establish base rates for various services and adjust them by provider to factor in geography, patient mix and quality metrics. Medicare-based pricing gives us the bench­mark needed to pay a fair price for services, rather than focusing on a savings of total charges; you can’t change what you can’t see.

Paying providers also enables employers to use plan design (our next core driver) to incentivize em­ployees to use lower-cost, higher-quality providers.

What Can Employers Do?

Employers that join purchasing cooperatives can use their collec­tive bargaining power to influence the change in health care that em­ployers want.

The Alliance’s solutions, like bundled payments and Medi­care-based pricing, are customizable to each of our members’ circumstances and their appe­tite for achieving cost-savings.

To learn more about how The Alliance uses Pay­ment Reform to cut costs and improve health care, contact us.

The Real Cost of Care

These efforts are moving us away from the fee-for-service model toward Total Cost of Care (TCOC) contract­ing. With TCOC, 100% of the care provided to patients is considered when analyzing reimbursements. This new direction helps identify patterns of overuse and inefficiencies in the health care system that remain hidden in a fee-for-service model. It also moves the risk traditionally born by employers for inefficient care and medical errors to the health systems.

We aim to identify cost-saving opportunities so we can reward provider partners that deliver the most cost-effective care to our employees and their fami­lies – the way health care should work.

Kyle Monroe

Kyle Monroe

Kyle Monroe is the VP or Network Developm & Provider Relations at The Alliance. Monroe responsibilities include creating and maintaining relationships with health systems, clinicians and providers to support The Alliance’s strategic goals of im­proving high-value health care and leading new purchasing strategies.

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