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How Collaboration Can Reduce Costs While Increasing The Quality of Care

As health care costs continue to rapidly rise, insurance companies are forming alliances with a wide range of companies – in health care and in other fields – to improve patient care and control costs.

Along with collaborating with primary care providers, specialists, inpatient acute care facilities, and skilled nursing facilities, health plans team up with vendors that deliver member communications and education. Health plans also work with other firms to analyze claims data — helping to create better efficiencies and outcomes.

The overall goal is to improve the quality of patient care and to decrease costs for employers and members, all while helping the member receive the right treatment, in the right setting, at the right time.

Communication for All

To achieve better health outcomes, insurers are teaming up with consulting firms to break down language barriers and focus on member and provider education and intervention.

Some health plans are taking steps to address member concerns and to keep the lines of communication open. Such steps may include:

  • Assessing which languages are spoken by member populations
  • Making an interpreter available to providers when needed
  • Using a translation firm, which makes patients and doctors more comfortable
  • Giving everyone access to information and making communication easier all around

In addition, doctors are also able to update the provider directories of health plans with their ethnicity and the languages that they speak. This will assist diverse members who have English as their second language to easily choose a doctor that they can communicate with. Keeping diversity in the forefront makes it easier for members to find a doctor.

Collaborating for Prevention

Encouraging members to practice preventive health care is widely regarded as a way to improve health and control costs.

One example is the concern of health plans with the rising rate of childhood obesity. It has nearly quadrupled in adolescents in the past 30 years, according to the Centers for Disease Control and Prevention. Partnering with families and their doctors to lower children’s risk of childhood obesity is crucial to helping children grow into healthy adults.

Another technique is for insurers to supply physicians with prevention posters throughout the year to raise awareness and educate their patients. A wide range of healthcare topics are addressed, including:

  • Preventive care
  • Women’s health
  • Men’s health
  • Heart health
  • Diabetes

Sharing Claims Data

Of course, the original collaboration is between insurers, hospitals and doctors. Some insurers are administering registration and review processes. By sharing data with vendors, insurance companies are helping providers give services that are medically necessary and appropriate.

Insurers are also collaborating with firms who use claims data to analyze members’ care. This allows the health plan to:

  • Give members information to facilitate access to better treatment options
  • Increase the awareness of gaps in care
  • Reduce variations in care and over-utilization
  • Create better efficiencies and outcomes

The priority is focused on ensuring that members are receiving appropriate, quality care while holding down health care costs.

Post-Acute Care: Spending At Its Highest

Another concern for insurers is post-acute care services. It is an opportunity for insurers to better manage utilization and outcomes.

Proper care transitions can lower readmission rates and improve clinical outcomes. This includes specific guidelines to transition from inpatient acute care to inpatient rehabilitation facilities, skilled nursing facilities, home or assisted living facilities. Getting the right care, in the right setting the first time allows members to get the level of services they need with lower out-of-pocket cost.

Palliative Home-Based Support Programs

Health plans are also teaming up with palliative care home-based support programs. These programs offer care support for physicians or specialists. They offer house calls, working with the patient’s current PCP and specialists. They serve as their “eyes and ears” in the home for these patients, offering services such as,

  • Medication management
  • Durable medical equipment orders
  • Administration, reducing the burdens on doctors’ practices.

These patients face chronic, life-limiting illnesses and they welcome the team of physicians, nurse practitioners, nurses, social workers and chaplains who will visit them at home. Because of collaborations like these, patients need less emergency and inpatient care, ultimately reducing cost for the member and employers.

Improving health and lowering cost is one of many goals of insurance companies. They also look for opportunities to analyze data for better efficiencies and outcomes for their members.

Collaboration furthers a plan’s ability to use proven data to drive patient care that is consistent, increase quality and decrease cost.

When thinking about coverage for your employees, employers should consider insurers who are working to deliver better member outcomes. . Employers want to ensure the insurance company of their choice is forming collaborations with hospitals, doctors and others to improve member services while decreasing costs.