As health care and the health care marketplace evolve, regional and local plans remain innovation leaders – constantly implementing clinical and service delivery improvement strategies and using their deep market penetration to drive higher value and performance.
ACHP supports these efforts by linking high-performing plans in dialogues and structured collaboratives about best practices and strategies for continued improvement and growth. We also draw on this experience to shape a public policy agenda that reflects key interests of our member organizations.
In 2007, ACHP’s member plans and provider groups will work together toward better cost, quality, and service outcomes – to provide consumers and other public and private sector purchasers with the health care products they need. Learning and innovation in the clinical and marketplace arenas, benchmarking to set the standard and goals for improvement, and public policy initiatives that reflect the best of what we learn are the backbone of these efforts.
I’m outlining below a few of our exciting new initiatives that are getting underway.
Winning in the Marketplace
Service Improvement Collaborative. Service improvement requires approaches that move beyond data collection and clinical improvement strategies to the person-to-person interactions of good customer service. Excellence in customer service is always complex, and it is even more so in network arrangements where patients are receiving services outside of affiliated delivery systems. Building on a very successful learning model, ACHP has launched a service improvement collaborative among member organizations aimed at identifying specific initiatives and strategies that have been shown to improve service and plan enrollee perceptions of their care. Through Web conferences and a site visit, participating plans will strengthen their service improvement efforts, understand best practices, and build a network of colleagues in other plans to foster information-sharing on service improvement. Specific areas of discussion will include:
- · building a culture of service excellence
- · measurement and benchmarking strategies in customer service
- · maximizing provider partnerships in shared service goals
Transparency – Best Practices. As costs rise and benefit designs change, consumers as well as public and private sector purchasers are demanding more information on the value, quality and cost of health plan services. Successful plans have addressed these challenges using a variety of tools and strategies, including:
- · personalized reports that explain to prospective customers what drives cost and the impact of health plan programs on those cost drivers
- · increasingly sophisticated information on quality, cost, and efficacy for consumers/members to use in choosing their providers and assessing treatment options
- · Health Risk Assessments to direct members to programs that better manage and prevent chronic conditions
In a ground-breaking series of meetings and Web conferences, ACHP member organizations will identify innovative strategies for performance measurement, payment structure, benefit design and transparency of this information.
Benchmarking Performance. ACHP’s HealthPlan Performance Gauge (HPPG) is our premier analytic tool for helping member organizations identify gaps in clinical and service performance, understand their performance relative to competitors, and model their U.S. Newshealth plan rankings. ACHP’s HPPG is released twice a year – once in August for new commercial results and again in November for new Medicare and Medicaid results. The HPPG incorporates clinical, service, access and utilization quality measures and is an outstanding tool to facilitate performance improvement. In 2007, ACHP will continue to refine and improve these tools to help member organizations reach or exceed their performance targets.
Branding, Marketing and Communicating Value. In the health insurance marketplace, the ability of plans to differentiate themselves from the competition can often be a key component in the overall success or failure of the organization. In 2007, ACHP will look at these challenges in the small group and individual markets. A highlight of this series will be an in-person meeting in Washington,D.C. on May 3-4, 2007 in which ACHP marketplace leaders will share their best practices and lead discussions around ways to address prominent challenges.
ACHP is also developing programs in a number of other areas, including chronic care management and coordination, effective wellness and prevention approaches, Medicare product evolution and operations management, and expanding service networks and strategic partnerships.
Making a Difference in Public Policy
ACHP’s public policy platform is integrally linked to our plans’ experience and the lessons of our clinical, marketplace and benchmarking work. Our agenda focuses on helping policymakers shape policy in ways that support the highest quality health care. To that end, we have been leading supporters of ensuring the highest standards for performance measurement – building on our legacy as the originators of the HEDIS® measurement process. We also were among the first to call for Medicare to use its payment leverage to promote performance improvement – a position the Medicare Payment Advisory Commission, the Institute of Medicine and the U.S. Senate have since endorsed. In 2007, we will use our position as quality leaders to help policymakers appreciate the value of high-quality Medicare Advantage plans as they debate Medicare health plan funding. We organize our policy work through monthly conference calls with member plan staff and periodic conference calls with the policy subcommittee of the board of directors.
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ACHP is a leadership organization that brings together innovative health plans and provider organizations that are among America’s best at delivering affordable, high-quality coverage and care to their communities. Drawing on years of experience, members collaborate, share strategies and work toward solutions to some of health care’s biggest challenges. Their work is the foundation for ACHP’s advocacy on behalf of better health care nationally. More information is available at www.achp.org.