Altarum creates value-based health benefit plan
As an alternative to high deductible health plans, Altarum, a health systems research and consulting organization, announced a new health benefit plan.
The Medical Episode Spending Allowance (MESA) Plan is geared for people with chronic or serious health conditions.
MESA provides incentives for members to get high-value care through a reference pricing model, in which consumers can choose providers by comparing prices.
Altarum will test the plan at pilot sites in the coming years. The company said pilots will include “willing employers and providers, current engagement in and familiarity with alternative payment models and a commitment to price and quality transparency.”
MESA will help consumers research providers by identifying applicable providers in the area and allowing members to view costs and quality ratings. Members would only pay out-of-pocket when “the cost of care extends above the specified allowance for a given episode of care,” according to Altarum.
The plan design takes a page from consumer-driven health benefit design of a decade ago, but provides the tools and uses a carrot rather than a stick in leading members to higher quality/lower cost providers.
One piece of the project is getting providers to accept financial risk, which is already happening. Health insurers have been implementing value-based care, bundled payments and alternative payment models. Payers and providers are also partnering in hopes of reducing costs and improving care and outcomes through sharing data and better communication. Thomas Robinson, partner at Oliver Wyman, recently told Healthcare Dive that 92% of the approximately 200 payer-provider partnerships launched in the past five years emphasize “value-based compensation in some shape.”