Entities other than the patient that finance or reimburse the cost of health services. In most cases, this term refers to insurance carriers, other third-party payers, or health plan sponsors (employers or unions).
Partners may include state associations of private insurance, groups of self-insured employers, the state Medicaid office, and the state insurance commissioner.
How to Partner with the Insurer/Employer:
Bridges to Excellence: The Colorado Business Group on Health
In 2006, a number of Colorado health plans and employers joined together to implement the Bridges to Excellence (BTE) diabetes and cardiac programs. Under the leadership of the Colorado Business Group on Health, these groups agreed to recognize and reward physicians who voluntarily applied to this national organization and who could demonstrate that most of their patients could meet rigorous standards for metrics on blood pressure, cholesterol, blood sugar and other vital statistics. Physicians are eligible for a per member per year bonus when they become BTE Recognized. When the Colorado program started, only four physicians had sought recognition. By December 2011, 670 recognitions to 334 physicians have been awarded. Since 2006, CBGH has observed that for diabetes, BTE recognized physicians have lower cost and lower utilization, consistent with BTE national findings.
Role of Public Health:
Health Care & Quality Improvement:
There is significant healthcare transformation taking place across the nation. This transformation focuses on health care and payer models that aim to improve the health of our population, improve patient care and lower costs. States and public health departments working on 1305 share these common goals and should be encouraged to work with partners at national, regional, state and local levels.
Partners to consider:
QIOs are charged with promoting health care system changes that will lead to improvements in cardiovascular and diabetes health. State cardiovascular and diabetes programs are encouraged to explore opportunities for partnership with QIOs & QINs especially on the Improving Health for Populations and Communities (IHPC) section of the 11th scope of work. In most states, you will find the QIOs working with physician offices, clinics, and other providers to create Learning and Action Networks (LAN) focused on achieving the elements of the Million Heart's® ABCS.
Partnering with QIOs:
Community Organizations & Programs:
National, state and local community organizations and programs play an important role in supporting the strategies of 1305. Strategies that promote team-based care and support self-management and self-measured blood pressure monitoring (SMBP) will benefit from involving and collaborating with community partners.
State and local community organizations can identify and coordinate existing supports and services. They can work closely with health care providers and health systems on clinical-community linkages and bi-directional referrals to support hypertension management. They can also help identify gaps in community supports and build capacity to mobilize resources and better respond to the needs of the population.
Partners to consider:
AHRQ Clinical-Community Linkages Website - Resources and research on clinical-community linkages to connect health care providers, community organizations, and public health agencies so they can improve patients' access to preventive and chronic care services.
Million Hearts® Partners
NACDD 1305 Domain 4 Website Community Programs Linked to Clinical Services