Managed care values quality over quantity

This is a sponsored article written by MAHP Executive Director Dominick Pallone for Crain’s Detroit Business. Read the rest here. 

As many of us anxiously await a resolution to the Major League Baseball lockout, I am confident there will be an overabundance of prospective players trying out for the Detroit Tigers at spring training this year. Unfortunately, the quantity of prospective players wanting to play for the Tigers has never been the problem. The challenge has always been identifying and assembling quality players to make for a winning team.

For decades, under both government and commercial sponsored health care, providers like hospitals and physicians were paid for simply showing up at tryouts. Under the old “fee-for-service” (FFS) payment model in health care, anyone that could swing a bat got paid, even if they struck out.

To address the spiraling costs of health care and lack of quality patient outcomes associated with overutilization of services under the FFS model, managed care health plans stepped up to the plate with a concept that values quality over quantity. Like assembling a good team, managed care health plans first began assessing the quality of providers, reviewing their patient outcomes and specialties, then setting up networks and implementing value-based payment structures for services.

While FFS is still a prevalent method of paying providers, studies have concluded that 
this model encourages 
overutilization, and it lacks measurable outcomes and fails to incentivize providers for patient preventative care and wellness. Managed care plans have begun implementing alternative payment models that valued 360-degree patient care and rewarded prevention and wellness efforts.

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