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MANAGED CARE October 2006. ©MediMedia USA

Managed Care Outlook

Health plans, employers seek common goals

Business health coalitions expect health plans to continue delivering what employers want for their employees and dependents in 2007. And while it's difficult to predict the future, there are four reasons for this bullishness, according to the National Business Coalition on Health (NBCH).

1. The drive for quality improvement. NBCH collected data from 250 health plans and ranked them according to how closely they met its criteria in each of 10 categories. Since health plans want to earn the highest possible ranking, one way to do so is to collaborate with employers and coalitions to improve the delivery of care.
2. Closer cooperation between health plans and employers. For this reason alone, employers are likely to get what they want from health plans, and health plans are likely to become more adept at delivering what employers want.
3. Use of a standard tool. More employers and health coalitions are using NBCH's survey tool. Health plans do not need to respond to a wide variety of requests for information from many different employers. By using a standard request form, employers and health plans streamline the process.
4. Ongoing tool refinement. NBCH has been using and improving its proprietary tool since 1996 to collect data on the care that plans deliver to employees and dependents.

Greater collaboration sought for 2007

• 36% of health plans are pooling data with at least one other health plan to measure and report practitioner or provider feedback
• 20% of health plans are pooling data with another health plan to facilitate feedback from practitioners to consumers
• 47% of HMOs and 57% of PPOs collaborate with employers to improve how plans deliver care to patients with asthma.
• 28% of health plans are giving periodic financial rewards to providers

Move toward tiered networks

• 21 percent of health plans offer tiered networks of primary care physicians
• 21 percent of plans use tiered networks of specialists
• 23 percent of plans include medical groups or IPAs in tiered networks

Source: Information on the NBHC program is at «http://www.evalue8.org/evalue8/»