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People-Centered Healthcare Works



Kim was just in her 40s when she was diagnosed with a rare form of breast cancer. She could hardly believe it when her doctor gave her the devastating diagnosis. Even more frightening, she needed aggressive chemotherapy and a stem cell transplant to help her survive. A collaborative medical team made all the difference. By working together, her medical team reduced her wait time for treatment. They made sure she received the best care in the most appropriate settings—and from providers with the highest quality ratings based on skill and outcomes.

“My job is to build networks of top-rated providers. This helps our members access the best possible care for optimal health,” said Dale Lyman, Meritain Health’s head of network and cost management strategy. “Real stories like Kim’s prove that value-based approaches change lives.”

Value-based partnerships put the patient at the center of the healthcare experience, with an emphasis on keeping people healthy. These networks of healthcare providers work together on a patient-by-patient basis. Instead of the patient swimming through a fragmented sea of various providers, value-based partnerships give the patient a purposeful team of doctors and specialists certified to ensure quality care and efficiency. And Meritain Health is in a unique position as a Third Party Administrator (TPA) that offers a carrier-level value-based product, plus the ability to build flexible provider networks. We’re able to offer value-based care solutions that include networks customized to our clients’ needs. The result? Better health outcomes for patients that result in reduced long-term costs.

Prior to working with Meritain Health, Kim’s employer was challenged to find a benefits plan to meet their needs. Spending on medical claims had reached over $11 million, with an increase in high-cost claimants. The health of their employee population had already been decreasing. Working with their consultant and Meritain Health for a value-based partnership, the employer started down a new path with a value-based plan administered by Meritain Health. This led to healthier employees and savings of close to $2 million on benefits spending.

Another aspect of a value-based relationship is helping patients avoid unnecessary and redundant healthcare services. This improves care efficiency, helping them get the right care at the right time—for improved health, but also cost savings. When a provider partners with the TPA and employer, it’s a people-first solution that results in improved health for the member, and lower costs for all.

Employees like Kim need to focus on their health and employers need healthy, productive employees and cost-effective solutions. And that’s the point of value-based care.

Because of her team of providers working together, Kim’s treatments were successful. She is now a breast cancer survivor.

Said Dale Lyman, “I am thankful to be a small part of Kim’s story, and always pleased to hear of the continued success of value-based care. My team works hard daily to build value-based care networks and provider relationships that help others.”

To read the full story of this value-based care client, please click here.