Insight to Action

Don't Overlook the Value of Good Health Plan Governance

14 December 2016

Our work with self-funded health plan sponsors striving to control costs and improve member health often reveals commonly overlooked factors that can have a big impact. This is especially true for healthcare systems where the organization’s business strategy overlaps with health plan objectives.

For example, our experience has shown that establishing a broad-based governing body that includes key stakeholders who are driving towards value based care is critical to achieving alignment and driving results. Good governance means having the right parties collaborating on key decisions for the health plan mindful of the plan’s population health strategy.

Governance was a fundamental success factor in our work with Southcoast Health, a not-for-profit health services system serving 33 communities in Massachusetts and Rhode Island, to develop an innovative domestic steerage and population health management strategy.

Right from the start, we worked with Southcoast stakeholders to establish a new governance structure that enlisted broad expertise from across the health system—including physician leaders, care managers, diabetes educators, pharmacists as well as professionals in managed care, finance, marketing, and other areas.

In this new structure an executive committee makes the ultimate decisions with input from a wellness committee and a clinical advisory committee. Together, these committees take the lead in establishing expectations and setting goals for the plan, providing ongoing performance improvement review across all aspects of the plan, and determining required resources, plan design, clinical programs, and other key areas to drive results.

Involving physicians in the governance structure has proven to be critical to the strategy’s success. As Southcoast’s chief medical information officer noted, “Physicians bring to the decision-making process an invaluable clinical perspective as well as the ability to recommend solutions that improve member health and make good economic sense. Participation also forges a partnership between the physician group and the plan that helps achieve their common goals: keeping patients healthy while controlling costs.”

By helping keep its strategy on track, this new governance structure helped Southcoast achieve impressive results, keeping cost increases under control and saving more than $17.2 million annually compared to the national average. Most importantly, it keeps all stakeholders connected to the decisions that drive continuous improvement and can support the organizational strategy in value-based care.

To learn the whole story, read our white paper, “Achieving the Triple Aim: How One Health System Reduced Costs and Improved Member Health.”