Teachers and school administrators face several, difficult constraints: lack of resources, heavy regulations, long hours, and expensive health benefit costs. Unfortunately, the cost challenge remains. The average family health insurance premium in the U.S. is approaching $20,000.[1] If the trend continues, some estimate that it could rise to 100% of U.S. median household income by 2033.[2] What’s more troubling is that nearly a third of health spend is for care with little to no value.[3]

While payors in the private sector are going so far as to create and manage their own performance-based networks in order to moderate spend, employers in the public sector are bound by tight state and federally-controlled budgets. Thankfully, some school districts can access high-quality, cost-effective health-plan solutions without having to build them from scratch.

 

What is a performance-based network?

Today’s performance-based or high-performance networks use smaller, carefully curated groups of physicians who have a history of producing positive patient outcomes using cost-effective methods. While traditional, broad networks use a fee-for-service model to reimburse physicians for the number of services they provide, high-performance networks reward physicians for delivering efficient, outcomes-driven care that drives down the total cost of care — and ultimately the spend for employers.

And high-performance networks are gaining popularity. Since 2014, employers’ implementation of performance-based networks has grown by 267%.[5] After all, they are one of the few tools employers have to restrained skyrocketing healthcare prices.

 

REDUCING HEALTHCARE WASTE AND SPEND.

unsplash 100 dollar bill close up-1The power of high-performance networks lies in their ability to effectively remove wasteful spending — that which is estimated to be $750 billion a year in the U.S.[6] Performance-based physician groups are incentivized through a value-based care model to exceed both quality and efficiency metrics.

They evaluate healthcare activities to ensure patient services are necessary and effective, reducing duplication, readmissions, and excess administrative costs. Then they use care coordination to ensure patients stay fully engaged with their personalized treatment plans. As a result of more thoughtful collaboration between clinical teams, patients, and employers, health plans built on high-performance networks are also elevating health outcomes of patients.

Now with employers and patients seeking more value for their healthcare dollars, a resurgence of high-performance health plans has hit the market and, this time, they are being embraced — that is, if they can prove they can close the gap between expense and outcomes.

 

BE WARY OF HIGH-PERFORMANCE PRETENDERS.

There is a reason why large employers have moved to a DIY-approach when it comes to building a performance-based network. Many broad network health plans claim to have a narrow network alternative. Yet, for these major carriers, existing contracts may prohibit efforts to cherry-pick quality providers for narrower network solutions.

The resulting solution may leave employers struggling with a choice between quality and cost savings. The way to ensure results from a true high-performance network is to use a health plan designed around its own high-performance network and using a value-based care model to deliver on the promise of quality.

Learn more about high-performance health networks and how your district can control healthcare costs while ensuring a healthy workforce.

An ISD Guide to Selecting Healthcare Benefits

 

REFERENCES

[1] https://www.kff.org/health-costs/report/2017-employer-health-benefits-survey/

[2] http://www.annfammed.org/content/10/2/156.full

[3] https://www.theatlantic.com/health/archive/2012/09/how-the-us-health-care-system-wastes-750-billion-annually/262106/

[4] www.pwc.com/us/medicalcosttrends

[5] www.pwc.com/us/medicalcosttrends

[6] https://www.theatlantic.com/health/archive/2012/09/how-the-us-health-care-system-wastes-750-billion-annually/262106/