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

S Tilley1, D Bomberger, T Ackroyd

  • 1Healthcare Research Affiliates, Mechanicsburg, PA, USA.

American Journal of Medical Quality : the Official Journal of the American College of Medical Quality
|January 1, 1996
PubMed
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Hershey Foods Corporation created a managed care plan to control rising health care costs. They collaborated with various stakeholders, analyzing quality and cost data to build a provider network.

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.

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  • 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.