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Gina Pferdehirt
Director, Public Relations & Community Relations
UPMC Health Plan

American Journal of Managed Care Article Analyzes the Benefits of Provider-Led Health Plans

Study shows how provider-led health plans like UPMC improve health care quality and patient satisfaction

PITTSBURGH (Jan. 14, 2019) – The American Journal of Managed Care® (AJMC®) recently posted a new article that highlights the benefits of provider-led health plans to improve health care quality and patient satisfaction.

The study noted that the integration of health care providers and payers offers numerous potential advantages to the patient, provider, and system, including superior clinical outcomes such as 18% higher star ratings from the Centers for Medicare & Medicaid Services (CMS), 6% higher effectiveness of care, and 18% higher patient satisfaction compared to non-integrated systems. The article also found that procedure rates were significantly lower among integrated delivery and finance systems.

Titled “Relationship Between Provider-Led Health Plans and Quality, Utilization, and Satisfaction,” the AJMC® article was authored by Dr. Natasha Parekh, senior advisor at the UPMC Center for High-Value Health Care and the Center for Value-Based Pharmacy Initiatives; Dr. Inmaculada Hernandez, assistant professor at the University of Pittsburgh School of Pharmacy; Dr. Thomas Radomski, assistant professor at the University of Pittsburgh Department of Medicine; and Dr. Will Shrank, chief medical officer for the UPMC Insurance Services Division.

Utilizing 2016 Medicare Advantage data from CMS, the authors researched both provider-led health plans and non-provider-led health plans across the U.S. for outcomes focused on quality, access, utilization, and patient satisfaction. A total of 86 health plans representing more than 17 million Medicare Advantage members were analyzed.

“Our findings suggest that provider-led health plans can leverage the strengths and resources of both insurers and providers to achieve the common goal of delivering high-quality patient care,” said Dr. Natasha Parekh, senior advisor at the Center for Value-Based Pharmacy Initiatives and the study’s lead author. “Provider-led health plans have the potential to utilize unified electronic medical records, integrate initiatives focused on high-value care, and streamline the interactions between patients and providers.”

Provider-led health plans that align payer incentives and manage services across the continuum of care can benefit patients, providers, and health systems.

“As providers bear increasing risk under alternative payment models, there is momentum to bring together health care providers and payment through provider-led health plans,” said Dr. Will Shrank, chief medical officer for the UPMC Insurance Services Division. “These results underscore that not all plans are alike – integration of the payer and provider meaningfully impacts the quality of care and experience of the member, and should be an important consideration when selecting a plan.”

To access a full copy of the AJMC® article, please visit www.ajmc.com/link/3498.


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.