HPTN -- Do you know what this acronym means?
Cathy Eddy, President, Health Plan Alliance
04/14/2015
If you were at our Spring Leadership Conference this month you may have seen Steve Valentine from the Camden Group put HPTN up on the flip chart. Every time someone mentioned narrow networks, he'd say -- We don't want narrow networks, we want High Performing Tailored Networks. Hence the new abbreviation -- HPTN.
Many of our members are using more limited networks in their exchanges, with certain employer groups and for Medicare Advantage plans. As integrated delivery systems are expanding their medical groups, we are trying to leverage the system components for "integrated" care.
Health Plans are going to be challenged by responding to the marketplace that wants the "high performing" aspect of the network, the networks that want to be "narrow" to drive volume and capture market share, but perhaps may not be performing at the highest level possible and how do we "tailor" our networks to get the performance levels that meet the market's expectations.
As integrated delivery systems are moving from fee-for-service to value-based reimbursement, the medical group's performance will be a critical success factor. The ability to move to high performance will involve compensation and incentive models, improved access, point of care information, meeting quality measures, documenting risk adjustment and the leverage of care extenders.
The ability of our health plans to work with health systems and medical groups to promote and measure high performance will also be important to the plan's success. Now customer satisfaction, access and quality measures can contribute significantly to the plan's financial results through STAR ratings, HCCs, HEDIS measures and state quality measures. In one of our plans a drop in their STAR rating from 4 to 3.5 was worth $15 million in lost revenue and for the delivery side lost reimbursement.
More of the work of the Health Plan Alliance in the future will be tied to the intersection points between our plans and their delivery systems and medical groups in their networks. So much of the success of plans is determined by the performance of their networks. We will continue to share resources for and approaches to analytical support, changing contracting strategies, integrated care management and governance structures.
This year we will kick off the expanded membership programming for health systems at our System/Health Plan Value Visit June 29-July1 in Salt Lake City. SelectHealth will be our host plan for this meeting. We encourage our plans to bring system leaders to the Alliance value visits and will be looking at designing some new ones for our delivery system partners.
So the next time you hear someone say we have a "narrow" network, ask them, "How do we become a High Performing Tailored Network?"
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