Shifting the focus from cost to value: a private payer perspective

To present the issues, concerns, and advances possible as private (commercial) payers attempt to incorporate value into their health care plans, using a commercial provider of disease and medication management as a model.

Most approaches to health care have dealt with persistent or chronic diseases, but, increasingly, payers are expanding their interests to include wellness, high-risk case management, and care management. Technology is crucial in health care today, enabling clinicians to reach out to patients, capture data, and integrate medical and pharmaceutical data. Data integration will help build efficiencies and effective ways to deal with the growing population of patients who have chronic disease. The disease-centric model is being replaced with a patient-centric model. Health care providers must help patients identify their unique motivators and de-motivators and encourage them to be self-sufficient partners in their own health care.

Adding value to traditional health care is a task that seems daunting at first. It is not insurmountable, however, and ultimately, adding value decreases cost in unprecedented ways.