Alaskans serve as test market for Premera Pulse platform
Alaskans enrolled in the individual and employer-sponsored insurance market with Premera can tap into an app that makes it easier to track their health care. Results will feed into a year-long pilot program before Premera opens the service to its
Designed in partnership with Vim, a healthcare tech company based in
The new service is meant to overcome the challenges patients face when searching for the right, "high-value" provider. In turn, Premera will be collecting information from consumer-driven decisions on health care providers and doctors.
Premera Blue Cross Blue Shied Alaska President Jim Grazko released news about the app at a time that coincided with a "Blueprint for Improving Our Nation's Health System Performance."
The plan authored by five state governors -- Gov.
In their blueprint, the governors present four guiding principals for transforming their health care systems. One of the aims is to "recognize state innovations in value-based care."
That's the direction the new app is also headed, Grazko said.
"This engages them before they go to a hospital or to see a doctor. It's not an app you download. It's not a website, and it's not a texting service. But it's a little of all those things," he said.
To access the app, Premera customers will be given a link that allows a one-time sign in. They will then be able to find in-network care (doctors that take Premera insurance), schedule appointments, access medication lists, get reminders about important preventive care visits, set up convenient appointment reminders and rate doctors after visits.
Nearly 10,000 people have signed up already and more than 300 booked doctor visits through the app, Grazko said.
"When enough people do the survey afterwards, that will be information you can use as well," Grazko said.
A prompt asks, "'would you like to see how others in your area, how their visit went?' It will allow you to know if they had long wait times, if they felt listened to... "
Premera can collect information from the "experience" recorded in the survey.
Premera includes all the physicians in its network and will get a better idea of which providers offer "high-value" care. For example, the insurance company knows of
"This is getting us toward increasing the value of health care, the whole value-based reimbursement approach," Grazko said. "These providers are not doing unnecessary tests. They are only doing the care necessary at the time."
Providers go by standard check-lists before determining which tests are necessary. So it's easy enough to find patterns among providers and facilities that pad their finances through unnecessary procedures, Grazko said.
They can also track the customer's health to determine how it's faring. The doctor is likely to get some credit if your overall health improves.
"Health status is higher or lower than standard and in general and over time, you can detect differences," Grazko said.
This also heads in the direction of paying doctors for outcomes.
"It's in our sights, not too far down the road," Grazko said. "We've already identified some primary care providers by tracking outcomes."
The goal is to shift to a payment methodology that keeps a person out of the hospital. "If you keep your population healthy rather than just cranking through tests and scans -- that's the next generation. It's value-based reimbursement," Grazko said.
The Blueprint
The governors' blueprint was written with the goal of producing better outcomes at a lower cost to governments.
In
The current unrestricted general fund budget for 2018 Medicaid is
According to the blueprint, "governors understand that while some issues may temporarily divide us, on most issues we can find agreement," including that it's largely up to individual states to transform their own health care systems.
One of the core beliefs expressed in the paper is that "we can and must achieve multiple, complementary objectives." The best approach is to "address multiple objectives simultaneously."
The paper contends states can "lead by example" using Medicaid and state employee benefits (and to a lesser extent, individual and small group markets) as a catalyst for change.
The strategy proposed for improving health care services is that the states "must align consumer and provider incentives, encourage more competition and innovation, (and) reform insurance markets," much as
The creation of the ARP with
Under the waiver, the ARP will receive
It's logical that now with the ARP program assisting the
Grazko said it's no accident that government and private enterprise are finding the same words and concepts.
"The ACA didn't control costs; it was a set of insurance regulations," Grazko said. "In switching to a value-based contract for large group coverage, the key is to get costs down."
To read the Bipartisan Blueprint for Improving Our Nation's Health System Performance, go to:
https://www.colorado.gov/governor/sites/default/files/bipartisan_governo...
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(c)2018 the Alaska Journal of Commerce (Anchorage, Alaska)
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