Healthcare purchasers, including state-based marketplaces, are making a push to move healthcare payments from volume to value and to transform the delivery system to promote quality of care. Covered California is seeking to do this through its contracting health plans and the qualified health plan (QHP) solicitation process. The most recent solicitation lays out key milestones for the 2017 to 2019 plan years. Beginning in 2017, during the annual QHP certification, a contracting plan will be required to "report on its strategies to ensure that contracting Providers are not charging unduly high prices and for what portion of its entire enrolled population it applies each strategy." Strategies may include various tactics to move toward value-based payments, drive enrollees to high-value providers, and engage enrollees in decision-making and their own health management.
Milliman MedInsight® can assist health plans and providers with developing appropriate strategies, identifying analytic requirements, and conducting analysis to support them in their network management, quality management, and transformation efforts. We will be releasing a series of articles on these related topics.