Actuarial management key to changing industry

by Jonathan H. Burroughs Key stakeholders must back up and align healthcare transformation mandates to achieve high quality and low cost with strong contractual incentives. Healthcare organizations increasingly create co-management or joint venture collaborative arrangements with physicians, large employers and third-party payers to meet the triple aim goals (improving population health, improving the experience of care, and lowering per-capita costs). UnitedHealth, the nation's largest insurer, will increase its quality/cost incentives to $50 billion within the next five years, and healthcare organizations increasingly partner with or own an insurance product to gain actuarial competence and manage risk successfully. To do so, many organizations seek partnerships with third-party payers, commercial databases and those with actuarial expertise to better manage risk and transition from discounted fee for service (FFS) to payment with significant incentives for quality, safety, service and cost-effectiveness. About 34 percent of health systems currently own a health plan and 21 percent more plan to create an insurance product in the next five years, according to the Advisory Board's 2013 Accountable Payment Survey. Nirav R. Shah, M.D., and Dave Chokshi, M.D., describe four fundamental models of partnerships between healthcare organizations/systems and insurance carriers in their October 2013 JAMAarticle, "Should Health Care Systems Become Insurers?" They include: Full...
Source: hospital impact - Category: Health Managers Authors: Source Type: blogs