Both provider and payer organizations need to find ways to consistently and cost-effectively interact with and coordinate patient-centered prevention and care. But it’s not just engaging the providers—it’s also empowering the patient to make better health care choices to prevent or manage illness.
Each day, people make decisions that affect both their health and, subsequently, their health care costs. The Centers for Disease Control and Prevention found that 50 percent of an individual’s health status is determined by behavior—not genetics, environment or access. Even when the best treatments are offered, patients do not always adhere to the prescribed treatments. Studies have shown that half of chronically ill patients do not follow long-term treatment plans. Patient-centered health management ensures that all individuals have access to reliable health care tools, resources and information to enable appropriate and lasting behavior change.
According to a 2006 study released by the Department of Health and Human Services, of the $2.3 trillion annual health care spend, about $1.5 trillion could have been prevented, delayed or curtailed through lifestyle modifications.
Under all commercial ACO models, payers and providers play a critical role in patient empowerment that can lead to better outcomes. For example, organizations can engage patients/members in wellness and health initiatives through targeted, timely communications and embedded advocates or other specialists. Such programs can reduce an organization’s risk exposure over time by increasing individuals’ awareness of the personal and financial benefits of better health.
Another patient empowerment technique is benefit plan design that drives positive member behavior, including the use of rewards for members who engage in improving their health or, for members who do not, additional premium, deductible or copayment increases.
In the next installment, we’ll discuss the relationship between individual health and population health.
This post is the eighth of an 11-part series that proposes structures and actions that characterize successful accountable care organizations. Click here to download A Model for Value-Based Provider/Payer Partnerships white paper that covers the subject more in-depth.
 Roy Amara et al. Health and Healthcare 2010: The Forecast, the Challenge (San Francisco: Jossey-Bass, 2010), 23.
 Michael A. Rapoff. Adherence to Pediatric Medical Regimens, (New York: Kluwer Academic/Plenum Press, 1999).
 Health, United States, 2006. (Hyattsville, MD: National Center for Health Statistics, 2006), cited in Total Population Health Management, (Minneapolis: UnitedHealthcare, 2009).
- A Model for Value-Based Provider/Payer Partnerships–White Paper
- Trailblazers in Accountable Care–White Paper
More from this series:
- Care integration requires re-thinking care delivery processes–Part 2
- Care integration requires re-thinking care delivery processes–Part 1
- ACO governance and organization models must build in accountability for providing integrated, high quality care—at a lower cost
- ACO Governance: Align Functions of the Operations Team to a Common Goal
- Engaging Physicians in ACO Development and Operations
- Upside and Downside Risk Should Be Part and Parcel of ACO Financial Arrangements
—Cynthia Kilroy, Sr. Vice President, Provider Strategic Initiatives, Optum