People stint on needed care when they are enrolled in high deductible plans, and for this reason, quality advocates are skeptical of cost-sharing's overall effect.
PLAINSBORO, N.J. (PRWEB) March 11, 2015
As The American Journal of Managed Care continues to mark its 20th year of publication, the editors invited another organization celebrating its own milestone to reflect on current issues in managed care.
Margaret O’Kane, the founding and current president of the National Committee on Quality Assurance (NCQA), reflects in the current issue on how far quality measures have come and the challenges that lie ahead, as payment is increasingly tied to quality. Today, 171 million Americans are enrolled in health plans that use NCQA’s HEDIS measures, and another 10 million from the Marketplace exchanges will be added.
In “Quality’s Quarter Century,” O’Kane discusses the essential tools for today’s healthcare consumer, as commercial insurance shifts from a business-to-business model to one that is increasingly delivered in a retail transaction. The challenge, O’Kane writes, is that the focus today is on cost-sharing, which can undercut quality. “People stint on needed care when they are enrolled in high deductible plans, and for this reason, quality advocates are skeptical of cost-sharing’s overall effect,” she said.
Tools that can make health plans better for consumers, if used appropriately, are:
- Benefit design, which should follow the principles of value-based benefit design;
- Network design, which can be used to steer patients to high-quality providers;
- Payment reform, which should be used to steer patients toward high-quality providers and to reward those who provide the best care.
O’Kane was also optimistic about the recent announcement from the US Department of Health and Human Services that Medicare has set a goal of 30% value-based payments for 2016 and 50% for 2018. “These goals are useful because they are specific, measureable, achievable, results-based and time-bound,” she writes.
About the Journals
The American Journal of Managed Care celebrates its 20th year in 2015 as the leading peer-reviewed journal dedicated to issues in managed care. Other titles in the franchise include The American Journal of Pharmacy Benefits, which provides pharmacy and formulary decision-makers with information to improve the efficiency and health outcomes in managing pharmaceutical care, and The American Journal of Accountable Care, which publishes research and commentary on innovative healthcare delivery models facilitated by the 2010 Affordable Care Act. AJMC’s Evidence-Based series brings together stakeholder views from payers, providers, policymakers and pharmaceutical leaders in oncology and diabetes management. To order reprints of articles appearing in AJMC publications, please call (609) 716-7777, x 131.
CONTACT: Nicole Beagin (609) 716-7777 x 131