The fallout of provider-sponsored health plans in the 1990s still creates concern among many health system executives today, but a whitepaper from Valence Health explores the steps delivery systems can take to better manage expectations when launching health plans today.
George Lynn, a member of the board of directors for Chicago-based Valence Health, and Philip Kamp, CEO of Valence, wrote the whitepaper, which shares the following four steps.
1. Think long term. "It's important to understand that insurance-related risk evens out over time, but can be variable in the short term," wrote Mr. Lynn and Mr. Kamp. "That means an organization may have years when it performs really well, and years when achieving profitability is more challenging." They recommend taking at least a three-year approach when developing a provider-sponsored plan.
2. Leverage payer expertise. "Success will depend on leveraging the knowledge of the system's employee base and by staffing the effort with domain experts," wrote Mr. Lynn and Mr. Kamp. "High-performing individuals from the delivery organization can and should provide their perspectives, but merging this insight with payer expertise will be critical to achieving the long-term goals of the organization."
3. Set appropriate expectations. Creating a long-term strategy that draws on payer industry expertise lets the provider set appropriate financial expectations. These realistic goals will help providers prepare all stakeholders for the startup costs and early results of the plan.
4. Invest in the right technology. As a payer, population health and utilization management are paramount to financial and clinical success. It's critical for providers to invest in technology that provides key financial and clinical analyses, and also aggregates data from all settings of the care continuum to provide a picture of patients' health that is as complete as possible.
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