Where Value-Based Purchasing is Still Nascent
HLM: Is it realistic to have a payer of your own?
Schnieders: That's a complicated question, and is tied in with developing our clinically integrated network. As we've been talking about establishing that clinically integrated network in Kearney, we'll also have a chapter in Grand Island, Lincoln, and Omaha.
Doctors here were concerned that a CIN would focus only on narrow networks. We did tell them we would be experimenting with narrow networks with our own covered lives only. The narrower network reduces variation, utilization and costs, and thus reduces premium.
They understand, as long as it's just our covered lives. Through that, we'll start tracking quality data. Primary care doctors know who the bad actors are. It'll be their peers deciding who's quality or not. Our new data registry that CHI has will show Dr. Smith and his 2,000 patients, and it can show how many have diabetes or other chronic conditions, and will show the ones, for example, who haven't seen an ophthalmologist in three years.
All the evidence-based data measures is in black and white, and we didn't have this before. Now it's very objective vs. subjective. We purchased a Medicare Advantage product and have bought into an actual commercial insurance company. So we're moving on the path of being an insurance product. In the near future, we could have a sizable presence and a product on the exchanges.
Philip Betbeze is senior leadership editor with HealthLeaders Media.
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