Partnering with Providers

Health plans must impact the cost and quality of care their members receive to compete in today’s environment. Members need to remain well, and those with chronic conditions need to be appropriately managed. Providers hold the key to influencing real member health improvements. With emerging shared-risk models such as patient centered medical homes (PCMHs) and accountable care organizations (ACOs), providers need tools, information, and supplemental resources to deliver the necessary care management and care coordination functions to share financial risk. In return, health plans must have demonstrable proof that these care management functions are being performed and that the desired outcomes are being achieved.