What is the role of health plans in value-based competition?
Health plans need to fundamentally change their roles to become health organizations. In the past, the strategies and practices of health plans detracted from value through bureaucracy, administrative costs, restricting physicians’ and patients’ choices, limiting services, attempting to micromanage medical practice, and having adversarial relationships with both providers and members. In order to create value, health plans must shift away from this “culture of denial.” They must support both physicians and patients with information and unbiased counseling, assemble results information on providers and treatments, and organize information and patient support around the full cycle of care. Health plans should offer comprehensive disease management and prevention services for all members. And, health plans must measure themselves, by tracking and publishing their members’ health results.
