Data initiatives: building a managed care network utilizing clinical performance data

Area of Science:

• Health Services Research
• Health Economics
• Corporate Health Management

Background:

• Rising healthcare expenditures necessitate innovative cost-containment strategies for corporations.
• Traditional indemnity health plans present challenges in managing and controlling costs.
• Proactive corporate health plan development is crucial for financial sustainability.

Purpose of the Study:

• To detail the development of a corporate-managed care plan by Hershey Foods Corporation.
• To explore the collaborative process of building a provider network for a self-funded health plan.
• To examine the organizational adaptations required for implementing a new managed care initiative.

Main Methods:

• Utilized data from the Pennsylvania Health Care Cost Containment Council for provider network selection.
• Integrated expertise from healthcare data consultants, insurance providers, and healthcare professionals.
• Incorporated input from employee and union representatives throughout the development process.
• Analyzed key indicators of quality and cost-efficiency in provider selection.

Main Results:

• Successful establishment of a managed care network through multi-stakeholder collaboration.
• Implementation of a data-driven approach to assess provider quality and cost-effectiveness.
• Identification of necessary organizational adjustments within Hershey Foods and partner groups.
• Demonstrated a viable model for corporate-led health plan innovation.

Conclusions:

• Corporate-sponsored managed care plans can effectively address rising healthcare costs.
• Multi-stakeholder collaboration and data analysis are critical for successful network development.
• Organizational flexibility and adaptation are essential for implementing and sustaining corporate health initiatives.