Through Partnerships and Payment Reform, ACHP Plans Lift Local Regions

The Commonwealth Fund recently published case studies on three regions that rank among the best in the nation on health care access and quality measures, despite income and poverty rates typically associated with poorer system performance.

The regions share several characteristics that help build healthier community, from multi-stakeholder partnerships to investment in information technology. Two also share the presence of ACHP health plans, which collectively represent a half-century commitment to their communities.

ACHP member plan Independent Health is improving quality of life in Buffalo and Western New York.

The case study describes Independent Health’s mission to lower costs and keep people healthy – dynamics that the plan’s president and CEO Michael Cropp, M.D., hopes will boost the area’s struggling economy. “We’re a community with limited resources that is finding ways to create more value in health care,” Cropp recently told the Buffalo News.

The area’s players believe strongly in collaboration, best exemplified by its regional health information exchange HEALTHeLINK, which Cropp chairs. In a past blog post, Cropp has explained how the sharing of critical information among hospitals, health plans and physicians has helped improve care delivery and control costs.

Member plan Priority Health helps Grand Rapids and west central Michigan perform especially well on measures of prevention and treatment quality, avoidable hospital use and costs of care.

The region historically expects accountability from its local leaders, according to the Commonwealth Fund report. Priority Health, which consistently scores at the top of the National Committee for Quality Assurance (NCQA) annual rankings, led the transparency trend in health care by becoming the first plan in the Great Lakes state to publish costs and quality information by procedure, facility and physician.

Priority created Healthcare Bluebook, an online database for members of 200 common procedures. Organized by zip code, the tool identifies what is considered a fair price for a given service and shows facilities and network physicians within each cost category.

Priority has also sponsored pilot programs to pursue best practices and pay-for-performance incentives to improve ambulatory care among participating providers. The Commonwealth Fund report emphasizes the region’s preference for efficiency and value, elements of Priority’s business model that make the plan a trustworthy community partner and push peers to follow suit.

ACHP plans are collaborators as much as they are innovators. Most importantly, they are committed to improving the health of the communities they serve.