The Alliance Roadmap to High-Value Health Care Core Driver Four: Benefit Plan Design

“A small group of empowered purchasers can change the system.”

Members who attended The Alliance annual meeting this year heard these words of encouragement from Suzanne Delbanco, Executive Director of the Catalyst for Payment Reform (CPR).

Suzanne provided many examples of employers influencing the value of health care delivery in recent years and explained how their work is becoming even more important, given physician and hospital consolidations. More and more research studies show that consolidation drives up the price of health care for employers. This is something that certainly impacts the markets where we buy health care, with few independent physician groups and hospitals remaining.

Employers have the power to demand better health care spend.  They just need to use it. This blog is the fifth in a series that explains how the four core drivers on The Alliance Roadmap to High-Value Health Care fit together. Our last core driver is benefit plan design, which accomplishes two important things:

• It makes the right care more convenient, accessible, and transparent to employees, making it more likely that enrollees choose cost-effective and high-quality health care; and
• It provides financial incentives for employees and their families to choose high-value health care that delivers better results for lower costs.

Benefit plan design is the driver that brings all the components of high-value health care together: transparency, payment reform, and provider network design.

Examples of Strategic Benefit Design

Financial incentives that reward enrollees for choosing higher-value health care are probably the most common benefit design strategy that employers utilize today. Network tiering is an example of this, where high-value health care providers are more affordable for plan participants. Providers who don’t want to be in lower tiers are driven to change their business model, usually by lowering their prices.

Employers are also using benefit design to help employees get the right care. According to Suzanne, 33% of employers today are increasing out-of-pocket costs for services that are overused or potentially inappropriate without an evidence-based approach. Others are lowering out-of-pocket costs for services that employees need to stay healthy, like diabetic supplies. Yet another strategy is offering advanced primary care through onsite or shared-site clinics at low or no cost. These providers can then help educate employees and refer care to high-value specialists.

What can Employers Do?

Employers can use the tools The Alliance has developed to create benefit plans that make high-value health care accessible and less expensive for their employees. Because when enough employers get involved and

provide these kinds of incentives, physicians will be motivated to improve the value of their care and make real change in the market. Please reach out to the Member Services Team to start strategizing today.

Learn More about Benefit Plan Design