Data initiatives: building a managed care network utilizing clinical performance data.
Responding to the rising health care costs of its traditional indemnity health care plan, Hershey Foods Corporation developed its own managed care plan as part of the company strategy to better control its health care costs. In developing a provider network for its managed care plan, Hershey Foods utilized data from the Pennsylvania Health Care Cost Containment Council and the expertise of many different groups, health care data consultants (Healthcare Research Affiliates), the insurance provider (Capital Blue Cross/Pennsylvania Blue Shield), health care providers, as well as the employees and their union representatives. Selection of providers for the network necessitated a data initiative that analyzed indicators of quality and cost efficiency. This article explores the roles of these different groups in building the managed care network for Hershey and examines the organizational changes within these different groups to accommodate the Hershey Foods project.
Tilley
S
S
Healthcare Research Affiliates, Mechanicsburg, PA, USA.
Bomberger
D
D
Ackroyd
T
T
Smith
A
A
Hamory
B
B
D054598:Blue Cross Blue Shield Insurance Plans; D003657:Decision Making; D006264:Health Benefit Plans, Employee / Q000458:organization & administration*; D006761:Hospitals / Q000592:standards; D007373:Interinstitutional Relations; D008329:Managed Care Programs / Q000458:organization & administration*; D017008:Negotiating; D009936:Organizational Innovation; D010414:Pennsylvania