ACOs Encourage Benefit Designs That Push for Value-Based Decisions

More hospitals and doctors are signing accountable care contracts that tie payouts and sometimes penalties to delivering better results at lower costs. Some in the vanguard of that approach want to tweak insurance benefits to nudge patients toward choices that help them do it.

In Arizona, Banner Health is negotiating with large employers for accountable care contracts to start next year, and health system officials are seeking changes to benefit designs that will “drive and incentivize positive behavior,” said Dr. Tricia Nguyen, chief medical officer of Banner Health Network, its accountable care organization.

Insurance is increasingly seen as a vehicle to encourage patients not only to embrace healthy behavior and manage chronic conditions, but also to consider less expensive treatment options, especially when a more expensive path promises limited benefits. Value-based insurance benefits may also promote access to preventive services and chronic disease management programs. While Medicare has launched a rapidly growing ACO effort, private insurers have more flexibility with benefit design and that is where providers say they see promise.

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Source: Modern Healthcare