By Eric Galvin,
President of ConnectiCare, and Jess Kupec, President and CEO of Saint Francis
Healthcare Partners, co-chairs of the Connecticut Health Council’s Value Based
Relationships work group
Health care is expensive in the Nutmeg State. The reasons are plentiful,
but a more informed and better coordinated utilization of our current system
could help to lower health care costs while improving outcomes and making it
more affordable for everyone. Access to quality, affordable health care is
attainable and is being modeled in an industry collaboration currently underway
in our state.
ConnectiCare and Saint Francis Healthcare Partners began taking a
closer look at the payer-provider relationship a couple of years ago. We
quickly identified some significant (and frustrating) challenges for consumers
under our current fee-for-service health care model. The process can be
confusing, uncoordinated, and often leads to duplicative or unnecessary
procedures with lower quality outcomes and higher costs.
We saw a window of opportunity to test a better approach to the way
payers work with providers; one that is collaborative, reduces inefficiencies
and duplication of activities, shifts the focus to the value of care, and
overall enhances the patient experience.
Along with ConnectiCare, Saint Francis Healthcare Partners and other
industry participants, The Connecticut Health Council
recently formed the Value Based Relationships work group. The group consists of
health plan representatives and provider systems, doctors, pharmaceutical
companies, consumer advocates, insurance brokers, various social services
providers and others. Working together and leveraging our collective expertise,
we can establish integrated models of care based on comprehensive metrics and quality
outcomes, rather than to continue to rely on the inefficient, disintegrated fee
per health care transaction model.
Our goal is to allow the health care consumer to pay for the quality of
outcomes rather than the number of individual services a system provides them. Our
pilot project is currently focusing on Type 2 Diabetes, and how each group
member is involved with the care process for treating that disease. By
beginning with this single disease focus, we are able to approach the best
outcome creatively and as an integrated system rather than as individual
So far, we are encouraged by the level of interest and cooperation of
industry partners, but we need your help. Contact Amy Cunningham at the Connecticut
Health Council to join this important effort at firstname.lastname@example.org
Also, check out our recent
column in the Hartford Business Journal
on the topic.