Insurer Hikes FFS Pay, Providers Notch Savings

Margaret Dick Tocknell, for HealthLeaders Media , June 15, 2012

Results from The Everett Clinic and The Polyclinic, two early adopters with a total of 18,000 Premera members, indicate that the total healthcare cost trends for these Premera patients in 2011 were 3% to 5% below the average cost of other Premera patients in the same region who have a regular physician. Maturi says that translates into savings of $1.2 million for The Everett Clinic and $2 million for The Polyclinic.

Lloyd David, CEO of The Polyclinic, says the group is trying to develop similar arrangements with other health plans. "We all know that payment based on volume isn't sustainable."

David says the Puget Sound-based clinic, which has more than 175 primary care and specialty physicians and serves about 170,000 patients, has incorporated Premera members into a number of existing programs such as its follow up after hospital discharge program and a program that contacts members after they visit the emergency department to help resolve the problem and to reduce expensive revisits to the ED for the same problem.

Premera wants to expand the payment program, but acknowledges that it may need to find different ways either to organize the delivery system or to adjust the payment methodology to enroll more groups.

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