Self-Funded Group Health Plan Purchasers’ Role in Evidence-based Clinical Quality Improvement
Education l Background Reading l Assessing Care Quality Systems
Frequently incentives to provide quality patient care based on good science and to avoid unnecessary procedures not supported by science are missing or are actually "disincentivized" in many health care organizations. This drives up cost, increases the incidence of patient harms and reduces the quality of patient care.
(Evidence-based medicine (EBM) is the use of the scientific method and application of valid and useful science to inform health care provision, practice, evaluation and decisions. If you have not yet read our Evidence-based Medicine Primer: The Importance of Critical Appraisal (Shocking Facts), click here for more background. For more background on evidence-based medicine, click here.)
We believe that self-funded group health plans have tremendous potential to help solve many of our key health care problems. We believe this can happen through being educated on the issues and then by creating incentives and at-time penalties to health care providers as well as coming up with other creative solutions to support quality- and value-health care.
Reasons for Self-funded Health Plans to Participate in Evidence-based Quality Improvement
- With your resources, you have the power to change incentives. You have the power to change the gateways to care.
- Many of your employees will play a larger role in sharing the costs generated by their choice.
- Increasingly, health care will rely to a much greater extent on more participation by your employees in the decision-making about various health care choices.
- Your employees need the best available information for participating in managing their own care.
- As an self-insured employer you need evidence that your providers are practicing evidence-based medicine (EBM).
- Self funded group health plans have an important role to play on evidence-base quality improvement teams.
You need to know what most health care professionals don’t know.
Next Steps for Self-funded Group Health Plans
Contact us to explore various options such as —
- How to support evidence-based quality improvement in your city or state
- How to use a checklist to evaluate EBM in the organizations with whom you contract
- How your employees can learn more about EBM
Delfini:
Links for Employers Education |
We can train you to understand the principles you need to know — without having a clinical or research background. |
Background Reading |
Tips designed to help you understand and apply some concepts from “evidence-based medicine” (EBM) to assist you to better evaluate health care information and make choices for your care.
Mini-primer on evaluating the science:
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Assessing
Care Quality Systems |
If at least 20 to 50% of all health care is inappropriate, then there is huge waste in health care — and, worse, many unnecessary patient harms. But how can you tell if an organization is truly practicing evidence-based medicine? Of course people will say they are, but most are not — how can you tell? We can help you. We offer a Health Care Quality System Assessment Tool and a FREE hour consult. Contact us.
And what about report cards on physicians and organizations? What about measurements for quality? Don't be misled! There are ways in which such reports may reward low quality performers and penalize high quality performers. |
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