To The Point

Monthly management payment models can improve access and care with incentives

As we move to value-based models of care, the role of the primary care physician will play a greater role in managing the overall care of their patients instead of just getting paid to see them. Incentives have always been a positive way to increase a desired effect. Under value-based models, paying a monthly management fee to primary care physicians has been a payment model that has gained strength over the years. However, many detractors to such a model have argued that paying a monthly management fee reduces the incentive for providers to provide access and care. In order to offset this possible occurrence, MissionPoint Health Partners added further incentives to increase access and provide certain types of care. These… read more

ACOs far from the HMOs of the ’90s

Today’s Accountable Care Organizations (ACOs) are quite different than the Health Maintenance Organizations (HMOs) of the ’80s and ’90s. HMOs effectively controlled costs, which plan sponsors liked. But their “narrow networks” were unpopular among healthcare consumers because they functionally prohibited seeing providers who were not part of the HMO. Americans value consumer choice and don’t take kindly to it being denied. Today’s ACO, an innovation of recent years in health plan management, incentivizes the health plan member to see providers in the network. Among providers within the ACO network there is a very high level of care coordination. But the ACO does not prohibit members from seeing providers outside the network. Additionally, technological advances since the heyday of the HMO… read more

Accountable Care Organizations [Infographic]

Accountable Care Organizations (ACOs) are the latest population health management model. If you’re still in the dark about ACOs, we’ve put together a handy guide to understanding how they work. The ACO model can improve care quality while also lowering costs, improving value for its members. To do this, ACOs reward outcomes instead of output, so healthcare providers get paid more when the people they care for do well. Accountable Care Organizations are networks of facilities and healthcare providers with a core of primary care physicians that work together with qualified care guides to provide holistic care. MissionPoint calls its care guides Health Partners, who are registered nurses that help guide Members through health and life challenges to achieve more… read more

The Accountable Care Organization at a Glance

This is the quickest-ever primer on the Accountable Care Organization (ACO). An ACO is a group of healthcare providers, both physicians and facilities, which are organized into a network to deliver and coordinate care for a specific population of people, like the employees of a self-insured employer. The network model is made up of hospitals, clinics and specialists, who revolve around a core of primary care physicians who are focused on delivering holistic care. Many ACOs have qualified health advocates who, in coordination and partnership with physicians, help members within of the ACO navigate the healthcare system and help them manage their own care. The providers in the ACO are not necessarily all under the same roof, but they agree… read more

Helping people maneuver non-clinical ‘life factors’ that exacerbate unhealthy lifestyles a defining aspect of population health management

It’s widely known now that chronic conditions and preventable diseases like diabetes and heart disease not only cause vast suffering but are costly. In an insured population, they are often the source of great cost. What MissionPoint Health Partners is observing is that when you provide individuals with a plan of care that incorporates great clinical care and roll-up-sleeves, hands-on support as the individual maneuvers the life factors that place him or her at risk in the first place, health status improves and costs go down. Patients often face hard realities that expand far beyond a clinic or doctor’s office: depression, food insecurity, inability to pay for medications, transportation challenges, complex family dynamics and isolation. Addressing these challenges, often called… read more

Population health management about focusing resources both on those at risk as well as those already suffering from chronic conditions

Self-insured employers and payers who want to improve health outcomes within their insured population, and cut costs while doing so, are wise to get away from the prevailing idea of simply directing the majority of health plan resources to individuals already suffering from specific preventable diseases. It’s true that individuals with chronic conditions are the highest-cost users of a health plan and have the greatest potential for improved health status. That’s why the “disease management” approach was such an innovation when it first arose. But the more reliable way to improve health outcomes and cut costs today is a significant evolution on that now ubiquitous model. MissionPoint has found that to really reduce costs and improve health, companies must move… read more

Root-cause intervention an opportunity to mitigate major depression costs

Depression is one of the most noteworthy root causes of costly conditions that doesn’t reliably present in the clinic. More than 15.5 million Americans have major depression – more then the populations of Chicago, Los Angeles, and New York City combined. That means that within every health plan are individuals living with depression. They suffer in myriad ways, and the treatment of depression’s comorbidities is particularly costly. Treating people with depression costs around $4,000 more annually than treating those without it, and a study in the Journal of Clinical Psychiatry found that: Only 40% of the costs associated with major depression are directly related to treating the condition. Major depression is associated with higher risk for heart disease, obesity, stroke,… read more

The Costly Toll of Major Depression [Infographic]

Chances are you could readily name someone you know who suffers from major depression. It turns out the number of American adults battling the condition exceeds the populations of New York, Los Angeles and Chicago combined. Take a look at the infographic for a visual snapshot of the costly toll of major depression.

The Power of Primary Care Providers for Business

As a business leader, do you actively encourage employees to designate and utilize a primary care provider? If the answer is no, you might want to reconsider. Primary healthcare benefits both employers and employees in a variety of ways — it is good for the health and well-being of your team, and it can have a tangible impact on your company’s healthcare costs. Keep reading to discover the power of primary care providers (PCPs), and how PCP attribution can benefit your organization: PCPs Provide Reliability and Convenience. From an employee’s perspective, selecting a PCP just makes sense. A primary care provider is more than a doctor; he or she is a trusted ally who understands the full extent of the… read more