Build a sustainable health system

All stakeholders―including patients, payers, providers, employers, governments, pharmaceutical makers, medical devices and diagnostic manufacturers, and new market entrants―face a myriad of ambiguities, opportunities and threats. All need to work together to create an efficient, flexible system that improves the affordability of healthcare, while coordinating care and payment with greater transparency and accountability.

Health plans are in a unique position because they touch every consumer along the continuum of wellness, care and chronic disease management. So how can your health plan organization become the agent of change, acting for the benefit of all? By shifting to a collaborator role, health plans can encourage behavior that improves individual health, builds trust and loyalty, and fosters improved outcomes. In so doing, the plan can reduce both medical and administrative costs, while increasing membership and revenue.

A transformative roadmap for health plans to create sustainable systems

Research by the IBM Center for Applied Insights reveals five key competencies that, when combined, can help build a more sustainable health plan system. Those include:

• Systems optimized to cost-effectively support advanced care models and business relationships, enhancing customer satisfaction.
• Improved ability to comply with regulations and support new care models, business relationships, and meet consumer expectations.
• Data used to personalize care, wellness and disease management, and improve business and clinical outcomes.
• Broader product and service diversification to drive growth, consumer loyalty and market agility.
• Dynamic business models to enrich performance and foster consumer health.

These findings are presented in a new executive report, The value of building sustainable health systems (PDF, 1.61MB). To develop the estimated value ranges, we modeled a hypothetical mid-size single-state, U.S. health plan covering 1.3 million people or lives and generating US$4.2 billion in commercial premiums. The model can be adapted to other types of healthcare systems to produce beneficial results.

Define your own course of treatment

Achieving full transformation depends on having well-developed competencies in place―from core systems to information management to marketing. By doing so, your organization can shift its business model more easily. The combination of competency and maturity is what can allow your business to achieve the parallel goals of reducing cost and increasing revenue.

Download The value of building sustainable health systems to learn more about capturing the benefits of health plan transformation. (1.61MB)

1. The Commonwealth Fund

2. Centers for Medicare and Medicaid Services, National Health Expenditure Projections 2010-2020

3. National Association of Area Agencies on Aging, Policy 2011 Priorities (PDF, 840KB)