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Rethinking Value Delivery In Health Plan Operations

The state of operations at most health plan organizations is one of upheaval. Most would agree that substantial change and stamina are needed for a healthy tomorrow.  In the course of interacting with dozens of health plan operations executives, we have listened to and discussed many of their most pressing challenges brought about by healthcare reform, the innovations they were pioneering, and their visions for the future building of a sustainable health plan operating model.

What did we find? Health plan leaders understand that they have a vital mission to create healthier and happier members through provider collaboration to support exemplary, coordinated, evidence-based care and wellness promotion activities.  At the same time, they must achieve operational excellence to reduce the costs and inefficiencies of their operations to foster health and wellness. Underpinning both thoughts is a notion that some of the fundamentals of today’s business model must evolve to be sustainable in the future. The recent foray of health plans, into the hospital and physician practice arena through acquisition, points to a forward integration strategy to gain more control of care delivery practices, visibility to evidence-based care and quality metrics, and pay for performance.

Overall, health plan operations executives consistently voiced a need for ongoing examination and diagnoses of critical areas for incremental improvement and often wholesale transformation.  One of the key areas was continuous focus on a sustainable operation that can achieve both business innovation and efficiency by proactively managing financial, cost and regulatory requirements for wellness and chronic disease management.

 

 

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HealthExec Today is an affiliate of MedMarket Intelligence, LLC, a health care solutions organization. For information on our other news resources, visit: http://www.MedMarketIntel.com

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