Health Insurance Payment Models

These are health insurance payment models that offer incentives for healthcare systems, physicians and patients to design interventions that improve health behavior, healthcare activities and overall health of patients. They include concerted efforts such to reward healthy behaviors and discourage non healthy actions. See which Organization Interventions work.

Accountable Care Organizations

See Accountable Care Organizations Examples

See what works

Episode-Based Payments

See Episode-Based Payments Examples

See what works

Patient-Centered Medical Homes

See what works

Patient Incentives

See Patient Incentives examples

See what works

Performance Based Pricing

See Performance Based Pricing examples

See what works

Provider-Based Health Plans

• Scripps Health and Cigna have created an alliance through a pay-for-performance model to sell HMO health plans among San Diego employers (1/12/17)

See Provider-Based Health Plans examples

See what works

Value-Based Care Programs

• UnitedHealthcare of Florida awards physicians $2M in bonuses tied to quality (2/27/17)
• Study says no evidence pay-for-performance improves outcomes (1/11/17)
• Blue Cross Blue Shield health plans, Cigna, and UnitedHealthcare are leading the way in alternative reimbursement structures such as bundled payment models and shared saving programs to expand their value-based care payment footprint in recent years. (1/17/17)
• Humana, Aetna, Cigna Invest in Value-Based Care Payment Models (1/6/17)
• UnitedHealth, Aetna, Anthem Near 50% Value-Based Care Spending (2/2/17)
• Doctors Earn More Than $148 Million In Quality Of Care Bonus Payments For Improving Health Outcomes, Addressing Care Opportunities For UnitedHealthcare Medicare Advantage Members (8/4/16)
• 4 strategies BCBS used to save $1B through patient-centered programs. These programs include BCBS' accountable care organizations, patient-centered medical homes, pay-for-performance programs and episode-based payment programs — emphasize prevention, wellness and coordinated care, in conjunction with reducing waste in the healthcare delivery system. (6/2/15)

See Value-Based Care Program examples

See what works

Value-Based Insurance Design

Health plan benefit design to increase health care quality and decrease costs by using financial incentives to promote cost efficient health care services and consumer choices

See Value-Based Insurance Design examples

See what works

Wellness Payment Models

See Wellness Payment Models examples

See what works.