The United States would derive greater value from its spending on health care if its dominant form of payment rewarded providers for quality of care, control over the total cost of care, and--most importantly--outcomes achieved.

Taking on the Challenges:

As new care delivery and payment models continue to proliferate across the U.S., a number of challenges are emerging:

Engaging Provider Participation

Getting Patients Engaged in their Health Care

Lack of Technological Advancement

Lack of Access to Data on Cost and Quality

Take Action:

To improve the health care system, employers should make value-based purchasing a factor in their choice of health plans for their employees. For example, employers should:

Partner with health plans to:

Increase the share of provider payments that are value-based and promote delivery system innovations that have been shown to deliver value.

Promote reporting of meaningful performance data focused on quality, efficiency, productivity, patient engagement and satisfaction, and health outcomes.

Support stronger relationships between individuals and primary care providers.

Support employee and beneficiary health care decision making

By increasing the transparency of performance information, providing consumer education tools, and implementing value-based benefit design.

Immediate Term

  1. Assess the broad array of current requirements for and levels of performance associated with providers in the markets in which you offer coverage
  2. Assess current payment models used by public- and private-sector payers to reimburse providers in the markets in which you offer coverage
  3. Partner with health plans to offer coverage options for practical, technology-enabled care delivery methods that have been shown to improve access and health outcomes, which may include telemedicine and remote patient monitoring

Near Term

  1. Promote demonstration of value through measurement, continuing to move toward a collection of meaningful performance measures associated with cost, quality, prevention, and the patient experience of care
  2. Measure and increase the percentage of payments to providers that are based on value and outcomes rather than volume
  3. Support stronger relationships between individuals and primary care providers
  4. Promote electronic information-sharing among providers, laboratories, and patients to support improvements in the cost, quality, and coordination of care and encourage interoperability of electronic health records to support such information-sharing
  5. Highlight coverage options that support technology-enabled care delivery, such as telemedicine, to promote adoption
  6. Promote transparency of clinicians’ (1) performance on a range of meaningful performance measures, including those related to cost, quality, prevention, and the patient experience of care; (2) ability to electronically exchange clinical information with other providers for transitions of care; and (3) ability for patients to electronically access and use information contained in their health records
  7. Promote the development of educational resources, guides, and tools to support employer implementation of strategies to improve the health care system

Long Term

  1. Continue to measure and increase the percentage of payments to providers that are based on value and outcomes rather than volume
  2. Educate employees about meaningful differences in performance among providers and implement value-based insurance design coupled with transparency tools to support beneficiaries in seeking care from high-value providers

On average, only 11 percent of payments are value-oriented while the rest remain largely fee-for-service.

Featured Strategies

Mark T. Bertolini

Chairman, Chief Executive Officer, and President, Aetna

Aetna is using a provider collaboration model through Medicare Advantage to improve the quality of care and lower health care costs, and providing clinical and IT infrastructure for accountable care arrangements.

Learn More

Scott P. Serota

President and CEO, Blue Cross and Blue Shield Association

Blue Cross and Blue Shield Companies are driving the shift toward value-based care models that put the patient first, move away from fee-for-service reimbursement to arrangements based on value, and instill accountability across the care continuum. Models in place at Blue Plans across the country include supporting a strong foundation in primary care, recalibrating hospital payment to align with quality and efficiency, and supporting a system of accountable care.

Learn More

Patrick Soon-Shiong, MD

Chairman and CEO, Institute for Advanced health and NantHealth

The Institute for Advanced Health and NantHealth are creating an integrated health platform that will serve as a comprehensive, cloud-based data exchange infrastructure to connect care providers with patients and integrate research with clinical practice. They are also partnering with organizations on a range of activities to support improvements in the delivery of care, access to care, and patient-centered care.

Learn More

Dominic Barton

Managing Director, McKinsey & Company

McKinsey & Company is applying data analytics to design and test new approaches for rewarding high-quality, cost-efficient health care delivery (including new payment models). In addition, it is helping health care providers improve their clinical operations, and it is working with both providers and health insurers to increase their efficiency.

Learn More

Lowell C. McAdam

Chairman and CEO, Verizon Communications

Verizon Communications is providing coverage for online care for its employees and delivering enabling technologies to support improvements in health and the health care system.

Learn More

Find out how you can share your business’ health care initiatives

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