Payers, Employee Benefits

How payers are playing a part in new value-based outcomes strategies

Value-based healthcare puts the focus on patient outcomes, but payers have a part to play as well. A panel at MedCity News’ INVEST conference discussed how reimbursement strategies can improve patient care and reduce costs.

From L – R: Chitra Nawbatt, global head of health assurance partnerships with General Catalyst moderates a panel with Kari Hedges, senior vice president, Market Solutions, Blue Cross Blue Shield Association and Michelle Zettergren, president of Labor and chief sales & marketing Officer, Brighton Health Plan Solutions


We are all consumers of healthcare, yet the products and services we receive are like nothing else we consume. Many people have personal stories about dissatisfaction with their care or its cost, explained Michelle Zettergren, chief sales and marketing officer of Brighton Health Plan Solutions. These sentiments lead people to consume less healthcare, resulting in even poorer health outcomes.

presented by

The reality is healthcare is broken, Zettergren said. But payers are playing a role trying to fix it. Insurance companies are coming up with new strategies that emphasize better patient outcomes as main goal rather than providing a higher volume of services.

Zettergren spoke Monday at the MedCity INVEST conference in Chicago during a panel discussion about payers and value-based care. She was joined by Kari Hedges, senior vice president, market solutions, for Blue Cross Blue Shield Association, which represents 34 Blue Cross Blue Shield companies from around country. The session was moderated by Chitra Nawbatt, global head of health assurance partnerships and innovation at General Catalyst.

Brighton works with health systems that want to have a direct relationship with a self-funded employer. For these relationships to have successful value-based designs, Zettergren said that the health system needs to provide a comprehensive offering of services for a particular patient. These systems can then incent employers to create benefit designs that steer members or employees to that health system. With this relationship, the employer and the health system are incented to work together to lower costs over time.

The healthcare industry has experience with models intended to control risks and costs. Hedges said she lived through rise of health maintenance organizations in the 1980s and 90s. The difference between the HMOs then and the value-based reimbursement models now is an alignment of incentives, she said. The alignment is between the patient and the primary care physician. Zettergren said that in a in a patient-centric relationship, primary care doctors are like quarterbacks, calling the plays that lead to the quality healthcare outcomes that are the end goal.

sponsored content

A Deep-dive Into Specialty Pharma

A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.

Another difference between HMOs and value-based care is the availability of data. Electronic medical records are a key tool for providers, Hedges said. When a patient shows up in the emergency room, knowing the patient’s previous history aids in the delivery of care. But one obstacle to this tool is the lack of interoperability between different systems. And data alone aren’t enough. Analytics are key to informing the treatment decisions that lead to better outcomes .

“It’s beyond the data,” Hedges said. “You can’t measure what you don’t know. You need the analytics on top of that.”

Photo by Walter Lim, MedCity News