To date, almost all plan designs lay primary accountability for outcomes on clinicians. if you accept the research that shows that 80% of the factors that influence clinical outcomes are outside the domain of any clinician or clinical provider, you see that this gap between accountability and the factors that influence outcomes must be narrowed.
Health insurance of the future must incorporate and balance the social and personal determinants of health with clinical performance to thrive.
To accomplish that goal, the core tenants of any plan design must optimize patient engagement, and alleviate some of the pressure on clinicians, ACOs, and CINs to achieve optimal outcomes.
The key principles of such plan design would likely include:
1. Patient’s not only at the center, but leading their teams.
2. A patient controlled EHR.
3. Shared financial responsibility with patients, physicians, and providers all partnering to achieve optimal outcomes through prevention, early detection, and evidence-based care management.
4. Price transparency.
5. Clinician guided self-care and monitoring.
6. Patient driven health data collection.
I would expect other commercial entrants into the mix with the next five years. Wishing them the best for everyone’s sake.