Shifting the focus from cost to value: a private payer perspective.
OBJECTIVE
To present the issues, concerns, and advances possible as private (commercial) payers attempt to incorporate value into their health care plans, using a commercial provider of disease and medication management as a model.


CONCLUSIONS
Most approaches to health care have dealt with persistent or chronic diseases, but, increasingly, payers are expanding their interests to include wellness, high-risk case management, and care management. Technology is crucial in health care today, enabling clinicians to reach out to patients, capture data, and integrate medical and pharmaceutical data. Data integration will help build efficiencies and effective ways to deal with the growing population of patients who have chronic disease. The disease-centric model is being replaced with a patient-centric model. Health care providers must help patients identify their unique motivators and de-motivators and encourage them to be self-sufficient partners in their own health care.


CONCLUSIONS
Adding value to traditional health care is a task that seems daunting at first. It is not insurmountable, however, and ultimately, adding value decreases cost in unprecedented ways.
Shurney
Dexter W
DW
Healthways, Inc., 3841 Green Hills Village Dr., Suite 300, Nashville, TN 37215, USA. Dexter.Shurney@healthways.com
D020811:Biomedical Technology; D019090:Case Management / Q000191:economics / Q000592:standards; D003363:Cost Control; D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000592:standards*; D017048:Health Care Costs; D006293:Health Promotion / Q000379:methods / Q000592:standards*; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000592:standards*; D008329:Managed Care Programs; D010346:Patient Care Management / Q000191:economics / Q000592:standards*; D017149:Private Sector; D011785:Quality Assurance, Health Care / Q000379:methods / Q000592:standards*