Become a transparency steward: Understand the needs of your specific employee population to buy the best benefits at the best price with the best outcomes. Be clear what those benefits cost the employee and the employer.
Take the driver’s seat to beat the market: Understand your role as the purchaser of healthcare for employees and join the ranks of employer activists, pursuing new solutions to lower costs, improve access and enhance quality.
Design a care menu, then manage it: This applies to both the health plan and add-on benefits outside of the health plan, with clear communication around the cost, action to be taken by the employee and expected outcomes if action is taken.
Find the right price: Benchmark the prices paid commercially against a common reference point such as Medicare. With this information, pursue value-based arrangements with high-performing and lower-cost providers, in addition to negotiating better contracted rates on existing fee-for-service arrangements.
Rethink your role to prove value: As employers look to bring together services across vendors and reconcile duplicative services, opportunity exists for payers to become integrators and even manage the performance of the services, even if the services are not offered directly by them. And for payers that have pursued vertical integration, now is the time to tap into the suite of product offerings to deliver savings to employers and consumers.
Build a value line: A value line strategy is necessary as employers and consumers look for high-quality care for a low cost. Providers armed with a value line strategy are more likely to be included in a health plan’s high-performance networks and are better positioned to directly contract with employers.
Understand how to manage risk: Providers should understand what risk they can take on to guarantee a health outcome and the cost structure needed to make them profitable in doing so. Providers should understand and manage both the risk inherent in their ability to deliver care and the risk of the population they are managing—from health status to the social determinants impacting their health—to help them design appropriate clinical interventions as well as non-clinical support services.
Redesign the care delivery model: Focus on having the right channels of care—from primary care to nutrition support to physical therapy—for the population being served. This could mean implementing a primary care model to manage both the utilization and price of healthcare through the care coordination and gateway role that primary care can serve. But this also means not allowing the primary care model to become a barrier to care.
Pharmaceutical and life sciences companies
Tell your value story using data: Try not to rely on the too-frequently-used research and development argument to justify the drug’s cost. Instead show the financial savings of the drug compared to other, potentially more invasive medical treatments.
Lead the way with alternative financing for specialty drugs: Pharmaceutical and life science companies should go beyond the basic outcomes-based arrangements currently in place and consider exploring and expanding alternative financing arrangements, such as subscription models for unlimited access to a product for a set period of time or a mortgage model to finance expensive specialty drugs over time.