In two previous blogs, we explored the ‘trust gap’ between healthcare payers and providers – its negative implications for patients, strategies to help mitigate the divide, a recent narrowing of this gap and the promising shift to a ‘payvider’ model. This payvider model, which is increasingly being used in the commercial market, is based on a vertically integrated approach in which payers and providers share in the risk and rewards of managing care.
At the core of the ‘payvider’ model is a shared interest in better understanding the needs of populations (especially those needing chronic care), building trust and communicating effectively for optimal health outcomes and financial reimbursement.
Evidence is mounting that value-based insurance design (VBID) and the principles on which it was built can positively impact the utilization of high-value providers and limit the use of services that are of potentially low value, ultimately helping plans improve health and quality, enhance consumer engagement and reduce costs.
Until recently, however, the VBID model was largely limited to the commercial insurance sector. But that changed last year, when the Centers for Medicare & Medicaid Services (CMS) began diving into the VBID model in its Medicare Advantage (MA) plans, which may ultimately bring this approach to some 53 million people aged 65 years and over.