Visit IPM Pulse, our blog dedicated to the healthcare payer community and Integrated Provider Management (IPM).

White Paper: Unlocking Affordable Care by Aligning Products, Care Models and Reimbursement through Network Design

Expenditures on health care in the United States continue to increase and are rapidly reaching unsustainable levels. Pressures by businesses, households and the government to address these escalating costs and ensure high quality health care are multiplying. Health plans are being challenged to re-evaluate how they can provide affordable care to each of their customer segments. Health plans are responding with product, care model and reimbursement design innovations. Current health plan pilots in each of these three innovation areas show promise. However, the ability to scale innovation from a pilot to an efficient operating competency remains elusive.

There are significant interdependencies between the three innovation areas. Therefore the alignment of products, care models and reimbursement designs is crucial to achieve operational scale and affordable care.

Network design aligns the three areas of innovation by:

• Ensuring that innovative products are supported by steerage to the right care teams
• Enabling the care teams to be structured to meet care model innovation objectives
• Enforcing the reimbursement guidelines to incent the desired provider performance

Efficiently operationalizing the network design is critical. This requires an integrated solution that automates network rollout, maintenance, reimbursement, and performance management. Utilizing flexible and integrated solutions will enable customization of affordable care to all customer segments and reduce administrative and IT costs.

Please complete the form below to receive the white paper via email.