New Marketplace
Clip
Jumping into Value-Based Reimbursement with Two Feet (02:44)

“Payers have not really delivered on what we — customers — want. We want streamlined plans. We want affordable plans. We want plans customized to our needs. And we aren’t seeing them,” says NEJM Catalyst New Marketplace Theme Leader Leemore Dafny. “At the same time,” she adds, “I can see that we employers are not necessarily engaging in the way that one needs to engage in order to get that kind of transformation.”

She asks what Lynn Garbee, Senior Director of Reimbursement and Collaborative Care at Cigna HealthCare, would like to see employers do to enable some of the exciting transformation payers are trying to promote.

“I would like employers to jump into the value-based reimbursement world with two feet. I feel like they’re doing it half-heartedly,” Garbee says. “I’d like them to actually collaborate with us, in trying to create a healthy workforce in the first place, with a culture of health, as a lifestyle decision.”

“I also want to see employers incent their employees to connect with a PCP that we have in a value-based arrangement, that PCP guiding their care and incentivized to do the right outcome for them,” she says. “We’re making it easy for them now. We have a PCP within 15 miles for 92% of our employees. That’s a lot.”

Garbee adds that they’re also making it easy through their concierge to guide the employers to providers, specifically collaborating with them and providing better care. “We want our employers to take advantage of that, but we feel like they’re not coming halfway to engage with the products that would get them to those kinds of providers. We’re building the networks and the reimbursement; we want them to help to motivate and light up their employees to really take advantage of it,” she says.

Garbee believes employers have the opportunity to string products together — behavioral, medical, pharmaceutical, vision — but often, they keep them distinct. “We can do more together, than we would with those [kept] apart,” she says.

Finally, Garbee explains that the way they’re evaluated is very much still like it was 10 or 15 years ago — by unit cost. “The way we’d like to be evaluated is how we’re keeping the patient population healthy with risk-adjustment PMPMs. That’s much more indicative of moving to a better health outcome world,” Garbee says.

From the NEJM Catalyst event Navigating Payment Reform for Providers, Payers, and Pharma, held at Harvard Business School, November 2, 2017.

More From New Marketplace

Hospital Readmissions Reduction Program (HRRP)

Medicare’s Hospital Readmissions Reduction Program was established by the ACA to combat excessive and costly readmissions. Learn about HRRP penalties, criticisms, and strategies to reduce readmissions.

Conceptual Framework for Evaluating Specialty Care Partnerships

How to Engage Specialists in Accountable Care Organizations

Should an ACO insource or outsource specialty care? Here’s a framework to help leadership decide.

Illustrative Examples of Health Policies, Possible Goals, and Relevant Evidence Base

Evidence-Based Health Policy

Having a clear framework for characterizing what is, and isn’t, evidence-based health policy is a prerequisite for a rational approach to making policy choices.

U.S. and Canadian Prices of Some Generic Drugs with U.S. Prices That Recently Increased by 1000% or More

The Price of Crossing the Border for Medications

The health and safety risks faced by the many Americans who cannot afford medications necessitate consideration of alternative strategies to provide less expensive medications.

Economic Investment and the Journey to Health Care Value — Part III: Health Care Purchasers

Early successes suggest that value-based purchasing programs can both transform employer-based health care and have a powerful and lasting impact on the economic strength of U.S. businesses.

Single-Payer Health Care Is the Favored Outcome of Future Payment Reform

Survey Snapshot: Deep Frustration with the Current Payment System

Many NEJM Catalyst Insights Council members are frustrated with the pace of value-based payments and expect single-payer health care to gain traction — though maybe not soon enough.

Value-Based Payment Models Payer-Provider Contracts Value-Based Arrangements

Economic Investment and the Journey to Health Care Value — Part II: Health Care Payers

Payers’ broad scale of investment in value-based arrangements makes a compelling case for the importance of sustained efforts to identify effective value-based payment models.

Four Principles for Navigating Payment Reform

The changes needed in health care are happening way too slowly. Health care stakeholders must insist on value in what they pay.

Economic Investment and the Journey to Health Care Value — Part I: Health Care Providers

Early evidence suggests that value-based payment and care delivery can transform our health care system, but providers must increase the momentum for this positive change.

Shift Toward Value-Based Payments in the Industry and at Organizations Is Accelerating

New Marketplace Survey: What’s Next for Payment Reform?

As health care reform struggles to gain traction legislatively, health care professionals report that payment reforms continue to move forward at a moderate pace, and indeed are essential to achieving the Triple Aim.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Value Based Care

185 Articles

Self-Insured Employers — The Payment-Reform Wild…

Without more private-sector leadership, U.S. health care will remain stuck in a fee-for-service system for…

Self-Insured Employers — The Payment-Reform Wild…

Without more private-sector leadership, U.S. health care will remain stuck in a fee-for-service system for…

What 21st Century Health Care Should…

Just as there is no such thing as good marketing or good manufacturing, there is…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now