Supply Side Reorganization – Total Cost of Care: Can a Member Truly be a Consumer?

The last 20 years of wellness, engagement and cost transparency tools has failed corporate America by most measures. Not for lack of effort – but rather due to structural realities in the health care supply chain- and the financing mechanisms behind it. Clear, demonstrable, longitudinal data sets show the history of these failures and the multiple iterations of various vendor/trends that have attempted to stem the health care “cost” tide.

This session will highlight the flaws behind many of the historical missteps – and how we may be at the precipice of real health care change due to “big data”; and the organization of care around this data. TPA’s, insurance carriers and consultants have access to data that can demonstrate the “total cost of care” for a population – and more specifically, which health systems are more effective in treating/keeping patients healthy.

For the first time since the days of the HMO, the “supply side” of the health economics equation is getting in the mix. Moreover, the data/technology, and incentive structure may align to give these organizations a real shot at success. The data is being used currently to create high performance/narrow networks across the United States. Employer sponsored health plans/HR Executives will be faced with tout questions about access vs. costs for their employee populations – as these new networks tout significant savings while sacrificing some choice/freedom from the typical PPO style network.

The emergence of high performance/narrow networks in the last few years shows a completely different approach to disease/clinical risk management. Further, as these networks begin to take actual financial risk via performance based reimbursement payments, there appears to be a large shift in the risk mix in health care financing. This will likely trigger a complete rethinking of employer vendor mix in the wellness/engagement space – as the clinical side begins to take ownership of these areas. We will use data and case studies to quickly demonstrate the “edge” of this trend – and how employers need to prepare themselves in the coming years.

  • Understand how “Total Cost of Care” data is putting pressure on carriers – and in turn will push employers – to make value judgments on the “choice and unfettered access” for the members.
  • Explain the cost/quality implications of TPA’s and carriers are being pressed to work with the supply side to create high performance/narrow networks.
  • Detail the “cracks in the foundation” of the PPO carrier/TPA model of organizing care – 90+% of all hospitals and doctors contracted is not a network, it is a retail funding mechanism
  • Understand the value/supply chain consequences – and what they mean to your organization (ie. Wellness, stop loss, network performance etc)

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