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This blog is part one of a four-part blog series that aims to go deeper into each of these four core drivers on the Roadmap to High-Value Health Care, as explained at The Alliance 2019 Annual meeting.  The goal is to provide transparency, helping employers get more value from their health benefit investment and driving real change in the market.

Transparency is the first core driver and has been a buzzword in health care for some time. But what does it really mean? At The Alliance, we’ve always defined it as putting accurate, comparable, and understandable information about health care cost and quality at employers’ fingertips, enabling them to share that information with employees and dependents to make informed decisions about their care.

It’s also being open and collaborative with health care providers about how we measure their performance so that we can reward them for value instead of volume. What is critically important to understand is how interdependent these pieces of the puzzle are. We can’t reward providers for value unless employers and consumers become active health care shoppers. And we know that won’t happen unless we help employers provide actionable information and help them align incentives for employees and their families to choose high-value providers. After years of advocacy on behalf of our members in this arena, we firmly believe this chain of events is key to driving change for the better at hospitals and clinics.

Transparency in Action

Many Alliance employers are using QualityPath® as the catalyst to make this vision a reality. Through QualityPath®, we provide reliable information to both employers and providers on specific areas of care, such as inpatient surgeries like knee/hip replacements and outpatient testing like CT scans and MRIs. Employers are then able to use that information in their plan design to encourage enrollees to choose providers that deliver great results at a lower price. We’ll talk more about benefit plan design in a future blog post, but this is a critical element.

We also offer bundled payments as an option for outpatient surgeries.  We know that transparent cost information is only half the battle, but believe it is preferable to choosing health care in a void. Many of the surgeries for both QualityPath® and bundled payments also come with warranties for additional peace-of-mind.  There exist major swings in costs per episode of care from one network health provider to the next, and that provides an opportunity for cost savings if employers learn to harness this information.

Quality measurement in health care has come a long way, but gaps remain between the information we need and what is available today. We are evaluating quality information from both publicly available and commercial sources and will soon invest in new, meaningful quality indicators to add to our comparative price information used by employers. Our health policy advocacy at both the state and federal levels aims to advance and accelerate these efforts.

What Can Employers Do?

Employees and their families want answers to questions about health care options, how much they cost, and where to go for safer, quality care. We want to help them find the answers. Our solutions are customizable to each of our member-employers’ circumstances and appetite for change and the ensuing cost savings. It’s going to take the power of many employers to be successful, but we will meet you where you are and bring you along on this journey. Members and their advisors are encouraged to contact their Account Executive as the first step.

 

Melina Kambitsi, Ph.D.

Melina Kambitsi, Ph.D.

SVP, Business Development and Strategic Marketing at The Alliance
Dr. Melina Kambitsi joined The Alliance in 2017 and leads the team responsible for membership growth and retention of the cooperative. Dr. Kambitsi comes to The Alliance from Network Health in Milwaukee and Menasha, Wis. where she was chief sales and strategy officer. In this role, she was responsible for sales and underwriting, strategic planning, product development and risk-based contract analytics. Earlier she was senior vice president of sales at Blue Cross Blue Shield in Honolulu, Hawaii and the vice president of sales, marketing and product development at Blue Cross of Northeastern Pennsylvania.

Dr. Kambitsi received her bachelor’s in international studies and her master’s and doctorate degrees in economic geography at The Ohio State University. She speaks Greek fluently as well as four other languages (Spanish, French, Romanian and Russian).
Melina Kambitsi, Ph.D.

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