Referrals have to be driven by data, that means PCPs refer solely to specialists who rating nicely on high quality and price metrics, as an alternative of behavior, private relationships, or assumed comfort. Traditional carriers are so big that their total leverage for driving down prices for a particular line of enterprise can be restricted. For instance, Carrier A doesn’t wish to get too aggressive with a well being system about pricing for industrial plans, because that could impact their Medicare business with that system. In addition, as a for-profit company, Carrier A needs to find its revenue someplace. And that’s far simpler to find in business plan purchasers which have long accepted the annual price increase as status quo. Newer, revolutionary well being plans can construct a community of solely high-value providers, slicing these providers’ opponents out of the community.
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