The value of investing in an integrated health care system

An integrated health care system strives to provide greater access to convenient, affordable care and innovative medicine. These efforts can help improve employee health and productivity and, in turn, strengthen the value employers receive.

How a provider-led health plan can improve employee health and deliver savings

COVID-19 reshaped how health care is delivered. As a catalyst for telehealth innovation and digital integration, it accelerated the shift from in-person visits to virtual care, particularly with provider-led health plans that realized the value of this care modality. As we move beyond the pandemic, care models will keep evolving to better support community members’ physical and mental health needs. Provider alignment is central to this shift because it reduces the fragmentation that makes navigation challenging for patients.

In this ever-changing this environment, choosing a health plan that’s part of an integrated health care system can provide peace of mind, flexibility, added resources, and cost savings to help you navigate into the future of health care. Efficiency, flexibility, and lower long‑term costs will be key in helping you capture the direct and downstream benefits your health plan can provide.

Why is health care so complicated for employers?

The U.S. is shifting from volume to value in health care—where the focus is on better outcomes, coordinated care, and lower total costs—but the journey isn’t an easy one. The health care system is complex, and there are many organizations and people involved. This can fragment care and force patients to navigate disconnected providers—driving up costs and reducing care quality. In an integrated system, consistent communication helps alleviate navigation complications for both employees and employers.¹

The many stakeholders of the health care landscape

There are several key components to today’s health care system: patients, payers, and providers. In an integrated model, information, insight, and care flow among these stakeholders to support coordinated care.

• Patients and their families seek care or guidance.
• Providers—doctors, nurses, care managers, community clinics, pharmacies, and hospitals—deliver the care.
• Researchers and research centers develop cures, ways of providing care, and insights to drive innovation.
• Businesses purchase coverage so their employees have access to preventive and acute care services.
• Government entities—at the local, state, and federal level—provide guidelines for care and regulate how it is provided.
• Entrepreneurs develop new technologies to try to improve the health care system.

With the millions of people who work in or interact with the health care system, it’s no wonder that things get complicated, especially when misalignment among stakeholders increases complexity and costs.

Consolidation vs. integration: What employers need to know

Traditional health systems are consolidating at a rapid pace.² For example, CVS has acquired Aetna. Amazon, Apple, and Google are gobbling up health care start-ups and designing their own health tools.

But consolidation is not the same as integration. Simply combining organizations under one logo doesn’t always mean a better value. Consolidation is a step toward integration—which requires shared resources, aligned incentives and processes, and a common vision and culture. But it’s just that: one step in a bigger process.

Bringing together siloed health care organizations to work as an integrated system can improve care efficiency and effectiveness. This approach allows providers and payers to collaborate in new ways, which can lead to the development, implementation, and scaling of novel, evidence-based approaches to things like:

• Preventing and managing chronic conditions through health coaching.
• Deploying digital tools like telehealth to increase access to care.
• Decreasing pharmacy costs through value-based pharmaceutical contracting.

Why UPMC Health Plan?

UPMC Health Plan operates as part of an integrated delivery and finance system (IDFS) with UPMC and the University of Pittsburgh Schools of the Health Sciences. Within this structure, providers and payers work together to deliver high-quality care at low costs.  This allows us to:

• Develop internationally renowned programs in transplantation, cancer, neurosurgery, psychiatry, orthopedics, and sports medicine through our affiliation with the University of Pittsburgh Schools of the Health Sciences.
• Establish a deep connection with providers who understand the needs of their patients.
• Align incentives to promote high-quality care at lower costs.
• Share knowledge, expertise, and technology with UPMC to more efficiently coordinate care.
• Study the best ways to deliver interventions, programs, and benefits to different populations. This can reduce unnecessary care and improve long-term health outcomes.
• Respond quickly to our communities during times of crisis. During the COVID-19 pandemic, our members of the IDFS researched the disease and possible treatments, provided information to the community, provided high-quality front-line care, and increased access to care and resources.

Integrated health care systems like UPMC’s can help employers maximize the investment they’re making in their employees’ health and wellness.