NEJM Catalyst Article Highlights the Benefits of Integrated Delivery and Finance Systems
The authors utilize
Titled "Effective Consolidation: A Model for Reform through Payer-Provider Integration," the NEJM Catalyst article was authored by Dr. Will Shrank, chief medical officer of the
The authors offer their perspective about how IDFSs can improve health care, particularly in the context of increased market competition.
According to the piece, for many years prior to the launch of
As noted in the article, the insurance market in Western Pa. today is highly competitive – with two IDFSs and multiple national insurers, the region has among the lowest-priced insurance products in the
The Catalyst article also illustrates how an integrated payer and provider system can work together to address critical public health issues, such as the opioid epidemic, to drive reductions in inappropriate prescription drug use and improve overall member safety through integrated data that supports clinical decision making.
The authors conclude that as policymakers consider options to improve the health of our nation and reduce health care costs, marketplace structure should be central. As seen in Western Pa., the integration of providers and payers working together to improve quality and reduce costs can produce better results.
The authors suggest that policymakers and CMS ought to consider ways to support new models of provider-payer collaboration that enable providers to develop key competencies, such as consumer engagement and member management processes, risk analysis, and reimbursement modeling. These competencies are essential for improving clinical quality, patient satisfaction, and costs within integrated systems.
To access a full copy of the NEJM Catalyst piece, visit https://catalyst.nejm.org/idfs-payer-provider-integration/.
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Social Security Rulings (SSRs) 96-3p and 96-4p; Rescission of SSRs 96-3p and 96-4p
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