BLOG — Partnering with Clinicians for the Best Coverage and Care

Consumers are all too frequently left on the sidelines as payers and providers fight over a slice of the $3.5 trillion health care pie. But when these two parties align and focus on the mutual goal of delivering the best possible care, patients win. Unlike other insurers, nonprofit community health plans and doctors are connected to each other, sharing a single goal: that patients should have the best quality coverage and care at the best possible price.

Alliance of Community Health Plans’ (ACHP) member organizations are paving the way with these patient-centered partnerships. Integrated within their communities, ACHP’s nonprofit plans forge deep relationships with clinical teams and rely on evidence to guide decisions — resulting in better health outcomes for everyone.

ACHP member organizations lead by example:

  • Capital District Physicians’ Health Plan, Inc. (CDPHP) partners with 218 independent local primary care practices and 1,026 practitioners in their Enhanced Primary Care (EPC) program. This model, which ties payment to performance rather than volume, improves the doctor-patient relationship, enhances care coordination and improves health outcomes.
  • Group Health Cooperative of South Central Wisconsin (GHC-SCW) trains physicians to screen and orchestrate a “warm handoff” of a patient directly to behavioral health providers embedded within clinic primary care teams. Demonstrating this success of payer-provider collaboration, GHC-SCW scored 5.0 on the HEDIS scale for helping adult patients adhere to anti-depressant medication for 12 weeks after diagnosis.
  • Independent Health’s Primary Value Program in western New York is shifting providers to a value-based payment model, leading to better quality and a more sustainable business model. Currently, 86 percent of Independent Health members see one of the 632 PCPs participating in the program.
  • SelectHealth in Utah partnered with obstetricians to establish new guidelines and declined payment for medically unnecessary early inductions of labor. As a result, procedure rates dropped from 28 percent to zero, leading to shorter labors, fewer C-sections and $2.5 million in annual savings for all.

Focused on innovation, care coordination and the patient experience, provider-aligned community health plans consistently deliver better value for our health care dollars.

For additional information on ACHP member organizations’ payer-provider partnerships, read ACHP President and CEO Ceci Connolly’s op-ed in The Health Care Blog.