Payers In Healthcare

Growing number of hospitals in the nation have introduced large gaps in hospital quality and safety, private and public payers have been aiming to push for quality improvement in healthcare through quality measurement and reporting initiatives. With quality measurement, comes difficulty for payers to determine which reasonable quality measures are vital, how to interpret and use quality information in a meaningful way, and how to present useful and actionable information to consumers, according to a new Policy Analysis from the National Institute for Health Care Reform (NIHCR) (Retrieved from Cassil A. & Cross D., 2013). As U.S. healthcare costs are persistently high and rising, “payers are incorporating clinical quality measurement into health
As while, the cost of healthcare has become unaffordable. The best approach in improving the value of healthcare is to improve quality and reduce cost, which perceive as odds with each other. The odds in this situation is that patients believe that lower cost means lower quality; on the other hand payers believe that higher quality means higher cost, which providers take in hand in requesting higher payments to maintain initiatives in progressing the quality of care delivery (Center for Healthcare Quality and Payment Reform, 2011). The alternative approach of payers and providers have been more influenced in developing combined strategies to develop better quality and low cost healthcare in current
Payers have been aiming to use data and analytical resources to define care opportunities for patients and care providers, while share quality information. Having data on multitude of quality and efficiency among care providers, payers offer decision support services and other sufficient information to help inform care choices that develop quality healthcare. Payers are developing better quality healthcare by having the ability to provide certain data to patients in support of them having the ability to choose a provider who can suit their needs and preferences (Sandy G., Tuckson V., & Stevens L., 2013). According to Sandy G., et al., their research stated that “since 2005 United Healthcare has deployed a national transparency program called UnitedHealth Premium Designation that provides consumers with information on costs and quality for more than 240,000 physicians across twenty-one specialties. This enabling role is being played today by innovative health plans as part of an ongoing transformation toward greater consumer focus and