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NEJM Catalyst Article Highlights the Benefits of Integrated Delivery and Finance Systems

Article illustrates how integrated health care systems such as UPMC improve clinical outcomes and reduce the cost of care

PITTSBURGH (June. 14, 2018) – The NEJM Catalyst posted a new article today that highlights the benefits of an integrated delivery and finance system (IDFS) to improve clinical outcomes and reduce the cost of care coverage.

The authors utilize Western Pennsylvania as an example of consolidation and then integration that lead to a more competitive health care market and drove improvements in quality while reducing cost. The authors contend that the payer-provider partnership, as illustrated by UPMC, eliminates silos and integrates real-time data to support improved clinical decision-making and optimizes clinical and financial performance.

Titled “Effective Consolidation: A Model for Reform through Payer-Provider Integration,” the NEJM Catalyst article was authored by Dr. Will Shrank, chief medical officer of the UPMC Insurance Services Division; Diane Holder, president of the UPMC Insurance Services Division; and Dr. Steven Shapiro, chief medical and scientific officer at UPMC.

The authors offer their perspective about how IDFSs can improve health care, particularly in the context of increased market competition.

According to the piece, for many years prior to the launch of UPMC Health Plan, Western Pa. was one of the nation’s least competitive health care environments. With the start of UPMC Health Plan in 1997, “the aligned payer-provider strategy focused on reducing low-value treatment and over-diagnosis, shifting services to the most appropriate lower-cost settings, preventing and managing chronic disease, and implementing more efficient, coordinated models of care.”

As noted in the article, the insurance market in Western Pa. today is highly competitive – with two IDFSs and multiple national insurers, the region has among the lowest-priced insurance products in the U.S. At the same time, the region experienced improvements in health care quality and considerable investments and innovation in medical science and health care delivery.

The Catalyst article also illustrates how an integrated payer and provider system can work together to address critical public health issues, such as the opioid epidemic, to drive reductions in inappropriate prescription drug use and improve overall member safety through integrated data that supports clinical decision making.

The authors conclude that as policymakers consider options to improve the health of our nation and reduce health care costs, marketplace structure should be central. As seen in Western Pa., the integration of providers and payers working together to improve quality and reduce costs can produce better results.

The authors suggest that policymakers and CMS ought to consider ways to support new models of provider-payer collaboration that enable providers to develop key competencies, such as consumer engagement and member management processes, risk analysis, and reimbursement modeling. These competencies are essential for improving clinical quality, patient satisfaction, and costs within integrated systems.

To access a full copy of the NEJM Catalyst piece, visit https://catalyst.nejm.org/idfs-payer-provider-integration.

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About UPMC Insurance Services Division

The UPMC Insurance Services Division is owned by UPMC (University of Pittsburgh Medical Center), a world-renowned health care provider and insurer based in Pittsburgh, Pa. The UPMC Insurance Services Division—which includes UPMC Health Plan, WorkPartners, UPMC for Life, UPMC for You, UPMC for Kids, and Community Care Behavioral Health—offers a full range of group health insurance, Medicare, Special Needs, CHIP, Medical Assistance, behavioral health, employee assistance and workers' compensation products and services to more than 3.4 million members. For more information, visit www.upmchealthplan.com.