AJMC May 13, 2021
This article is co-written by Suzanne Delbanco, PhD, MPH, executive director, Andréa Caballero, MPA, program director, and Julianne McGarry, MPP, director of projects and research, for Catalyst for Payment Reform, and Robert S. Galvin, MD, chief executive officer, Equity Healthcare, LLC.
The relationship between health plans and self-funded employers is on increasingly shaky ground. Almost every employer relies on health plans to pay doctors, hospitals, and pharmacies for the health care services their employees and families use; since the 1980s, employers and other health care purchasers have entrusted insurers to manage these expenditures wisely.
To this end, health plans have exercised utilization review, network contracting strategies, and condition management programs in their stewardship efforts.
Their success is questionable at best....
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