- Value-based healthcare is a payment model for delivering healthcare in which providers (including clinics, hospitals, and more) are paid based upon conditions, episodes, outcomes, and overall health rather than being paid a fee for each service provided.
- Often the distinction between in-network and out-of-network can be confusing. An in-network facility can house an out-of-network provider, which means little to no coverage and high costs. A change in insurance might block access to a doctor you’ve had for years – or make them a costly option.
- Clear “pathways” or trained navigators from health plans can help you know what is covered, and when, through your specific plan.
- Though the pharmaceutical supply chain has become complex and convoluted, innovative business models are emerging that reduce prices for patients reliant on drugs – such as transplant recipients who rely on immunosuppressants to keep them alive.
- While affordability of and access to healthcare is important issues to you as a patient, it is also valuable to your employer to invest in your long-term health.
- Because employers don’t necessarily know the full impact of their decisions about coverage, advocacy as an employee is important to ensure you and are able to access the care you need.
- As employers design their health plans, they are investing more in prevention and primary care to reduce ill health and expensive hospitalizations downstream.
- When encountering any obstacles with bills or coverage, it is critical for you to reach the right person – a stakeholder within an employer or insurance company that has the authority and the incentive to help.
- You are the expert in your own experience – and there are many resources with helpful information and advocacy organizations excited to partner with you as you advocate in the insurance world.
- Experience navigating the insurance system as a patient means that you can provide key insight and feedback in generating innovative solutions in healthcare coverage.
To learn more, watch the full A3 Payer Summit recording here:
