Using Self-Insured Data as a Foundation for Value-based Payment Strategy at Adventist Health

John Beaman, Chief Business Officer, Adventist Health, and Allen Miller, Principal, COPE Health Solutions.  As CMS and employers continue to push for more premium risk contracts and value-based payment, a key to success is accurate data on the total cost of care for attributed or assigned membership. There is a growing understanding that building the capabilities to understand and better manage health for a health system’s own self-insured employees and families is highly translatable to other populations and payers, for direct-to-employer strategies. Using employee utilization, cost, and outcomes data, health systems can optimize their network for specific provider and service types, understand patterns of care to improve convenience and employee satisfaction scores, and improve quality and health outcomes. Health systems can use their self-insured plan as a key “payer” to understand how to analyze claims and related data, and develop and launch population health management infrastructure. John and Allen discuss how Adventist Health has leveraged the claims data for its employee health plan as a foundation for a larger value-based payment strategy.