Commercial Payers

The U.S. uniquely stands out as a country that relies heavily on private health insurance. Commercial health insurance coverage accounted for 160 million lives in 2004, voluntarily provided by employers.  Commercial health care payers see opportunities to improve health care, with an increasing interest in leveraging technology to improve quality and efficiency of health care delivery and financing.  In addition, employers are investing more resources in trying to inrease employee engagement in their healthcare, through personal health records, increased transparency to healthcare costs, and other measures.  As the commercial payer industry evolves, there are opportunities to improve care delivery with interventions enabled by technology.  New connected health programs would be most effective if coordinated with current efforts to promote healthy lifestyle choices, performance-based payments, and continuous information exchange.

External Resources

Developing A Performance-Based Incentive Program for Hospitals: A Case Study from Maine

This case study provides useful lessons learned from a performanced-based incentive program piloted in Maine, driven by a private-public partnership.

May 2007 | Nalli GA, Scanlon DP, Libby D

High-Performance Health Plan Networks: Early Experiences

This document provides lessons learned from early adopters' experiences on using high-performance network providers.

May 2007 | Draper DA, Liebhaber A, Ginsburg PB

Commercial Health Plans' Care Management Activities and The Impact on Costs, Quality and Outcomes: Congressional Testimony

This congressional testimony covers commercial health plans' care management activities and the impact of those activities on healthcare cost, quality and outcomes.

Wednesday, April 11, 2007 | Draper DA

Health Information Technology Is A Vehicle, Not a Destination: A Conversation With David J. Brailer

An interview with David Brailer, the first U.S. national health care information technology (HIT) coordinator. Brailer provides his insightful views on the role of HIT for healthcare systems improvement.

March 2007 | Brailer DJ

Pay for Performance in Commercial HMOs

This study aims to provide a systematic analysis of the extent and nature of pay-for-performance programs among private-sector health plans.

Thursday, February 22, 2007 | Rosenthal MB, Landon BE, Normand SL, Frank RG, Epstein AM

Shifting The Focus From Cost To Value: A Private Payer Perspective

This document presents private payers' perspective on incorporating value into their health care purchasing by using disease and medication management models.

August 2006 | Shurney DW

Private Payer Reimbursement for Telemdicine Services in the U.S.

This report provides a current landscape of private reimbursement for telemedicine services in the U.S.

February 2006 | Whitten P, Buis L

External Resources

Developing A Performance-Based Incentive Program for Hospitals: A Case Study from Maine

This case study provides useful lessons learned from a performanced-based incentive program piloted in Maine, driven by a private-public partnership.

May 2007 | Nalli GA, Scanlon DP, Libby D

High-Performance Health Plan Networks: Early Experiences

This document provides lessons learned from early adopters' experiences on using high-performance network providers.

May 2007 | Draper DA, Liebhaber A, Ginsburg PB

Commercial Health Plans' Care Management Activities and The Impact on Costs, Quality and Outcomes: Congressional Testimony

This congressional testimony covers commercial health plans' care management activities and the impact of those activities on healthcare cost, quality and outcomes.

Wednesday, April 11, 2007 | Draper DA

Health Information Technology Is A Vehicle, Not a Destination: A Conversation With David J. Brailer

An interview with David Brailer, the first U.S. national health care information technology (HIT) coordinator. Brailer provides his insightful views on the role of HIT for healthcare systems improvement.

March 2007 | Brailer DJ

Pay for Performance in Commercial HMOs

This study aims to provide a systematic analysis of the extent and nature of pay-for-performance programs among private-sector health plans.

Thursday, February 22, 2007 | Rosenthal MB, Landon BE, Normand SL, Frank RG, Epstein AM

amphitheater small2008 Symposium - October 27-28, Boston, MA
Who Provides, Who Decides, Who Pays: Consumers, Clinicians & Business Models in the Connected Care Era  Click here to learn more

 
Private Payer Reimbursement Information DirectoryThe purpose of this website is to provide a reference to support private payer reimbursement for telemedicine clinical consults. The information contained in this website is the result of a survey jointly sponsored by the American Telemedicine Association and AMD Telemedicine.
The Leapfrog GroupThe Leapfrog Group is a voluntary program aimed at mobilizing employer purchasing power to alert America’s health industry that big leaps in health care safety, quality and customer value will be recognized and rewarded. Among other initiatives, Leapfrog works with its employer members to encourage transparency and easy access to health care information as well as rewards for hospitals that have a proven record of high quality care.
Bridges to Excellence Bridges to Excellence is a not-for-profit organization developed by employers, physicians, health care services, researchers, and other industry experts with a mission to create significant leaps in the quality of care by recognizing and rewarding health care providers who demonstrate that they have implemented comprehensive solutions in the management of patients and deliver safe, timely, effective, efficient, equitable and patient-centered care.
Ambulatory Care Quality AllianceAQA is a coalition of the American Academy of Family Physicians (AAFP), the American College of Physicians (ACP), America’s Health Insurance Plans (AHIP), and the Agency for Healthcare Research and Quality (AHRQ). Their goal is to lead an effort for determining, under the most expedient timeframe, how to most effectively and efficiently improve performance measurement, data aggregation, and reporting in the ambulatory care setting.
 

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