"Insurers need to become a strategic orchestrator of services. They will need to shift away from just paying claims … [and] start assuming the role of a 'strategic payer'"—The Geneva Association
A recent brief from The Geneva Association defines the role of what it calls New Care Models (NCM), an expansion of value-based purchasing (VBP) that includes five distinct models and incorporates life insurance as a factor in whole health planning. Based on a literature review and stakeholder interviews, the brief matches these models to multiple impact criteria and defines NCM drivers. Their key recommendation is for payers to shift from simple claims processing to strategic players through better risk stratification and partnerships that lead to full risk-sharing over time.
According to the Geneva Association, NCMs are marked by holistic, continuous, and coordinated care with a patient-centered approach that includes aspirations and spans individuals, communities, and policymakers. The result should be comprehensive, a "[s]hared responsibility and accountability for population health, tackling the determinants of ill-health through intersectoral partnerships."
The Geneva Association identifies three key industry drivers for NCMs:
- Greater numbers of older, sicker patients with more complex medical and whole-life needs
- Increasing healthcare costs and the mounting burden on consumers via higher premiums and deductibles
- Public funding strains as the number of private and public-private ventures grow
These drivers—combined with multiple impact criteria and the diverse rationales for NCM adoption—can lead payers to the ideal NCM option. Using a supply-and-procurement lens, the Association recommends options that shift from traditional approaches:
- Multiple Accountable Care Organization (ACO) models
- Global risk and full payer-provider integration
- Direct-to-consumer services, delivered by providers
- Consumer-directed purchasing based on needs and resources
The brief's authors identify the strengths and weaknesses of each model based on eight criteria, ranging from outcomes, consumer attractiveness and market potential, and provider/organizational capabilities to care utilization influence, insurer risk, and cost containment potential. Under these criteria, the ACO models rank the highest, surpassed only by global risk, fully integrated approaches.
The authors' final recommendations include a value chain that delivers for consumers, distributors, providers, and organizations alike and that marries health and life insurance planning. What does this mean for payers? The brief notes: "Insurers need to become a strategic orchestrator of services. They will need to shift away from just paying claims, start assuming the role of a ‘strategic payer’ and ensure a favourable supply-side condition that can fulfill the promise of NCMs made to policyholders."
Laura Beerman is a contributing writer for HealthLeaders.
KEY TAKEAWAYS
The Geneva Association has defined a comprehensive suite of New Care Models for payers and providers to consider as they migrate from traditional care approaches.
In their research brief, Association authors identify the strengths and weaknesses of each model by mapping them against consumer, provider, and organizational factors as well as outcomes, cost, and risk.
The authors conclude by defining a value chain where health and life insurance planning are intertwined, and where payers know how to fully stratify, manage, and share risk.