There are also incentives for practices to meet quality targets and a shared savings program for primary care physicians. Other states, such as Alabama, are adopting similar models and incentive systems to manage and deliver care.
5. The uninsured. The Camden (NJ) Coalition of Healthcare Providers uses care management programs for the uninsured and is putting accountable care principles to work for some of its most fragile citizens. A citywide project targets residents with both complex medical conditions and social issues—the same individuals who overuse emergency departments and hospitals. Coalition members, such as social workers, outreach workers and nurses, help patients stabilize their social environments and manage their health conditions. The result has been a significant reduction in healthcare costs.
6. Individuals. Frustrated by increasing premiums, business leaders are backing away from employer-sponsored health plans. Instead, they are giving employees lump sums to purchase health insurance directly. In states such as Massachusetts, individuals are purchasing insurance through an exchange, buying policies with deductibles and benefits that suit them.
Succeeding in the individual market will depend on finding the right payer that is willing to design products for individuals, and partner to help manage care. To keep costs down, it will be essential to include effective care and chronic disease management programs into the benefits package.