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Thought Leaders

Empowering Hospitals and Healthcare Systems to Improve the Patient Experience


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Perceived value is everything, regardless of the line of business. Things that cost more come with higher expected value. This is true for consumers when shopping for high-ticket items such as cars, homes and appliances—and healthcare is no exception. With the rise of high-deductible health plans, healthcare consumers find themselves paying more out of pocket than before, and this puts a microscope on the level of care they’re receiving. It’s reasonable to assume when patients are expected to pay more for their care, they will in turn expect a level of care that meets this increased cost. It’s just like purchasing anything else—you expect to get what you pay for.

How can hospitals and healthcare systems deliver what patients want?
To remain competitive, hospitals and healthcare systems must maintain a good reputation in the community—one of positive patient experiences and high-quality providers. By improving patient outcomes, a facility can offer value to its customers. Enter the concept of value-based care.

What is value-based care?
This recent concept focuses on improving the delivery and quality of healthcare being received by the patient thus improving the patient’s health and reducing employer and employee costs—to provide increased value. The value-based care model moves care from a fee-for service model to one based on fee-for-value. The model revolves around the following five core principles:

1. A focus on overall patient health
2. Providing more efficient care (e.g., better communication between physicians, avoiding duplicate services, etc.)
3. Increasing member engagement in their own care
4. Increasing care management (e.g., increased outreach to high-risk patients)
5. A focus on information and analytics to provide actionable data

The main takeaway is that if a hospital or healthcare system can improve the delivery and quality of care, a patient’s health improves and costs go down for everyone (patients and employers). It’s a win-win.

Accountable Care Organizations (ACOs)
Into any conversation about value-based care enters the concept of ACOs. This healthcare model is built from networks of physicians rewarded based on management of patients’ overall health and achieving defined criteria. This is in direct contrast to the traditional means of payment based on quantity of patients seen and tests ordered. Accountable care providers share information, coordinate decisions about patients’ care and develop proactive solutions, as well as emphasize preventive care and employee education. They’re specially certified as high-impact and efficient. As a result, these providers are able to find at-risk patients and help them get the care they need. In short, ACOs deliver exactly what value-based care is based upon—physician collaboration and improved quality, efficiency and affordability of patient healthcare. 

So what if a hospital or healthcare system could infuse ACO-like policies and procedures into the way they provide patient care? This would improve the level and value of care they’re able to offer consumers. And, in fact, this is a reality—by becoming an ACO-like provider!

What it means to be an ACO-like provider
Meritain Health offers capabilities to help hospitals and healthcare systems achieve a higher level of service for their own patient population. By choosing from an a la carte menu of ACO-like components, providers can build the following into their healthcare offering:

• Flexible plan designs—for all the programs and services needed for healthier members.
• Integrated wellness programs—to impart health education.
• Tiered domestic networks—to improve steerage to in-house physicians and services, with carrier-level out-of-area wrap networks for comprehensive coverage.
• Automatic payment suppression—to bypass cutting checks to domestic providers
• Account management, resources and support—for answers to plan questions, and guidance members need to use their healthcare
• Seamless medical management—for member health awareness and self-care
• Robust reporting and analytics—for a deeper understanding and insight into plan performance

How hospitals and healthcare systems can provide value
They must be able to deliver the level and quality of service your patients and clients are looking for. Incorporating a value-based strategy (like becoming an ACO-like provider) is one way to provide patient-centered service, with a focus on wellness and managing chronic conditions. This culture change from reactive to proactive care, plus care efficiency through physician collaboration, goes a long way to provide the value healthcare consumers seek, plus help hospitals provide to their community a more marketable product and higher level of service.

About Meritain Health

Meritain Health works with hospitals and healthcare systems to improve quality and value of care plus cost savings, to maintain a positive reputation as a high-quality provider in the community.

We work with our clients every day to understand their unique population health needs and what’s driving up plan costs. As Advocates for Healthier Living, we help our clients build efficient health plan strategies. We offer easy-to-use healthcare and ancillary benefits your employees can use to lead healthy, productive lives.