Plexus builds bridges between insurers and care providers
The health care insurer as director, as care purchaser, as regional partner, as designer of disease management concepts. Insurers are still finding their feet in the range of new roles open to them. Will care consumers shop around based on all the comparison information available to them or will they simply continue to prefer their local provider?
The answer is complex. Health care insurers will, increasingly, differentiate themselves. The Dutch Health Care Insurance Act permits (and even encourages) insurers to implement an active purchasing policy focusing on specific target groups. Increasingly, health care insurers themselves bear the risks of expensive and poor care purchasing. This is drastically changing the rules of the game and, as a result, the skill and knowledge base that health care insurers need to be able to call on. There is increasing scope for real negotiation on price and quality.
Some worry that this change will lead to a literally unhealthy polarization within the health care market. Plexus is convinced that the opposite is the case. Care providers are being given the opportunity to implement innovations that distinguish them from competitors. Alliances can be struck with the insurers in relation to specific parts of the process. This tendency can already be seen in chronic care (for example, diabetes care). Care providers and insurers are actually joining forces to produce a combined offering to the patient/insured party. Similar developments can also be observed in elective care (for example, for cataracts and inguinal hernias), although their effect is very different.
Plexus actively assists health care insurers in three areas:
- Care purchasing for health care insurers: definition and implementation of purchasing strategies (‘results-driven purchasing’), restructuring of the care purchasing department, providing tailored training.
- Building bridges between the insurer and the care provider: preparing and implementing business plans from the perspective of both the care provider and the insurer. This brings the common interests shared by the care provider and the insurer into focus.
- Public training course in care purchasing for hospitals and mental health care institutions: a course lasting several days, which health care insurers and care providers participate in together. The course covers the new style of care purchasing, by reference to four topic areas.
Want to know more?
Contact Mark Lenssen:
T +31 (0)20 3010800
E lenssen@plexus.nl