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New Report Shows High-Value Provider Networks Maximize Quality, Affordability for Consumers

July 14, 2014 Comments off

New Report Shows High-Value Provider Networks Maximize Quality, Affordability for Consumers
Source: America’s Health Insurance Plans (AHIP)

High-value provider networks are part of a broad array of strategies health plans use to maximize health care affordability and quality, and a new analysis from actuarial firm Milliman for America’s Health Insurance Plans (AHIP) offers additional insight into how health plans develop these networks to improve care delivery and value. The report finds that high-value provider networks allow for more affordable coverage options with 5% to 20% lower premiums compared to broader network plans, while placing an emphasis on the quality and effectiveness of providers.

To achieve high quality and cost-effective care, health plans’ high-value network designs are focused on delivering care through more efficient treatment protocols, which resulting in the elimination of wasteful spending. In that regard, these initiatives address the cost and quality challenges in a comprehensive way—not simply though implementing smaller or narrower provider networks.

While health plans continue to offer broader coverage options, creating high-value networks—or contracting with a select number of providers who meet quality, cost, and effectiveness metrics—is one way health plans address the wide variation in the price of services and care delivery. In addition, the report highlights that high-value provider networks are “specifically geared toward providing personal and comprehensive care to patients in an environment where providers effectively communicate and coordinate with each other regarding the best treatment for the patient.”

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Research Brief: Insurers’ Efforts to Prevent Health Care Fraud

June 18, 2011 Comments off

Research Brief: Insurers’ Efforts to Prevent Health Care Fraud (PDF)
Source: America’s Health Insurance Plans (Center for Policy and Research)

This report presents updated information based on AHIP’s 2010 study of fraud and abuse claims, detection strategies, and reported savings attributable to anti-fraud efforts from 2006 to 2008. The study included both quantitative data collection and open-ended questions that allowed anti-fraud professionals to describe their views and challenges.

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