Wednesday, March 2, 2011

Success Factors in Five High-Quality, Low-Cost Health Plans - The Commonwealth Fund

Authors: Robert A. Berenson, M.D., and Teresa A. Coughlin, M.P.H.
Contact: Robert A. Berenson, M.D., The Urban Institute, rberenson@urban.org
Editor: Deborah Lorber

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Overview

In this report, the authors conducted case studies of five health plans that received high scores on quality and resource utilization, using data collected by the National Committee for Quality Assurance. The focus of this study was to understand how health plans with delivery systems that include a significant network of independent, community physicians achieve high performance. Plan leaders identified several factors they believe contribute to being a high-performing plan: building a physician–plan partnership, establishing the plan as a resource for physician practices, providing physician quality and cost data on performance, and emphasizing a local area orientation. Because employers are primarily responsible for arranging the health insurance coverage for their employees, there is market pressure for health plans to work with broader networks than they would otherwise want, which in turn interferes with the factors that lead to high performance.

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