Payment Reform In Health Care



The Alliance® aims to establish payment reform in health care by aligning financial incentives that reward providers for high-quality care using a Total Cost of Care model, where 100% of the care provided to a patient is considered when analyzing reimbursements. This helps us identify patterns of overuse and inefficiencies in the health care system that remain hidden in a fee-for-service model. We turn those inefficiencies into data included in our Smarter HealthSM analysis, which can be used to help guide individuals towards higher-quality care that saves them and their employer money. This model also moves the risk traditionally born by employers for inefficient care or medical errors onto health systems; its promise is to identify cost-saving opportunities by system so we can reward provider partners that deliver the most cost-effective care to our employees and their families.

Achieving payment reform in health care by creating the right incentives for care delivery is the platform upon which The Alliance was built. We’ve used our strength in numbers to pursue unique contract provisions that protected our members and their employees from unexpected charges. And we are building on that foundation to include a focus on cost and quality transparency to continue the payment evolution.

Real Payment Reform in Health Care

Reference-Based Contracting by The Alliance®

We’ve implemented Reference-Based Contracting by The Alliance (or Medicare-based pricing) in over 80% of our contracts. This is important because Medicare is the single largest purchaser of health care in the US and has established base rates for various services, and they adjust them by provider to factor in geography, patient mix, and quality metrics.

Reference-Based Contracting by The Alliance provides the benchmark we need to pay a fair price for services, rather than simply focusing on a savings of total charges. Paying providers a percentage of Medicare not only gives us an appropriate benchmark by which we can measure relative value, it also enables employers to use plan design to incentivize employees to utilize low-cost, high-quality providers.

Changing incentives will cause disruption in our health care system, and ultimately improve the quality of care, expand access to care, and reduce the cost of care for both employers and patients.


Bundled Payments

The Alliance contracts bundled payments for a select set of services. This simplifies pricing by packaging all the elements of a surgery or test together into one price. We are contracting additional bundled pricing for specific procedures so patients can know the cost of their care upfront and plan for the costs more effectively.

Featured Insights on Payment Reform

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