Healthcare Cost & Quality
| Jun 21 2017

How to Maximize Momentum For Healthcare Transformation

Renya Spak
Renya is a Partner in the New York City office of Mercer Health & Benefits and leads the Health Innovation Team. The Health Innovation Team is responsible for cultivating new thinking and designing solutions that address the dynamic challenges impacting employer-sponsored healthcare in the US today. Renya continues to actively participate and lead consulting engagements that focus on strategic planning, population health management, and health innovation.

Those of us who believe it’s high time for employers to lead the charge for value in healthcare were heartened by a recent commentary in CFO by Michael Thompson, who leads the National Alliance of Healthcare Purchaser Coalitions.

“As the largest purchasers of health care outside of the federal government, employers have been left with little choice but to chart their own course and drive for health-care quality and value,” writes Thompson. “Purchasers have always had the most balanced perspectives on the health-care system — valuing the need to support and improve the health, well-being, and productivity of their workforce while needing desperately to manage the costs and value of a runaway system.”

To that end, Thompson notes the emergence of employer coalitions and a number of strategies – from consumer advocacy efforts to onsite clinics, enhanced wellness efforts, combined purchasing power, and leveraging artificial intelligence.

It’s encouraging to note the growing consistency and momentum in the market around this concept of employer-led transformation. At Mercer, we not only support the National Alliance’s position, we want to do all we can to build on it. Here are some foundational actions we believe should be taken by employers to make meaningful progress against the goal of creating a more rational healthcare system that supports employers' strategic objectives:

  • Pay to value: It's time for employers to understand what percentage of their covered workforce is being cared for by a provider with a value-based reimbursement model. This means knowing how much you’re paying in additional fees for lives attributed to value-based reimbursement models, like ACOs and PCMHs. Organization should request carrier reporting that includes the expected and actual impact of value-based reimbursement on cost, quality and member experience.
  • Drive to Quality: Organizations should inventory all the sources of quality information from current vendors and determine which source to promote. They should evaluate plan design options to create a meaningful cost differential between seeking care at high- and low-quality care settings, and modify carrier contracts to exclude payment for “Never Events” (serious events that are preventable).
  • Personalize the Experience: It’s time to hold vendors accountable for achieving a high Net Promoter Score (NPS) by including a performance guarantee or contract provision. Employers also should offer services that provide high touch/high tech support to drive employees to become more empowered consumers, either through existing or new vendors.
  • Embrace Disruption: Employers should review procurement and contractual requirements associated with out-clauses and forming new partnerships with start-ups. Organizations must create the business case for change with internal leaders, socializing the business imperative.

These steps – along with the strong support of the National Alliance and other industry voices – will go a long way toward achieving what once seemed far from reach, but no longer need be: an employer-based healthcare system that works for all of us.

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