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coordination of care and the value necessary to be reimbursed under a fee- for-value reimbursement model.241 This change in the financial structure will influence insurers, as financers of heath care, to transform into a more coordinated structure as well.242 As payment structures adapt to the value incentives, the traditional structure of the current healthcare delivery and financing systems must adapt as well. For example, “hospitals that enter the insurance business may be able to better design quality care programs by becoming a unified organization and removing competing incentives.”243 Coordinated care is thought to be the industry’s route to achieve the ultimate goals of high-quality and cost-effective health care.244 “Blurring the lines between insurers and providers and ushering in the era of coordinated care” will achieve the integration within the delivery and financing of health care that is necessary to achieve quality and cost goals.245 Value-based reimbursement models transfer financial risk and clinical control to the providers and away from the payors.246 New responsibilities, payment structures, and reimbursement pressures will force healthcare systems to take on new roles beyond the role as the mere provider of health services.247
B. The Proposal
The structure of today’s health insurance companies is changing.248 The traditional and current health insurance market will transform into a system that incentivizes stakeholders to deliver low-cost, high-quality health care. The main stakeholders in the healthcare financing system primarily include
241. Joe Mott, By Aligning Financial Incentives, Intermountain Healthcare Will Help Everyone Who’s Involved in Healthcare Get Better Results for More Affordable Cost, INTERMOUNTAIN HEALTHCARE (Jan. 14, 2015), https://intermountainhealthcare.org/blogs/ 2015/01/aligning-financial-incentives-will-help-lead-to-more-affordable-costs. 242. Bob Herman, Providers Becoming Payors: Should Hospitals Start Their Own Health Plans?, BECKER’S HEALTHCARE (Jan. 30, 2013), http://www.beckershospitalreview. com/finance/ providers-becoming-payors-should-hospitals-start-their-own-health-plans.html [hereinafter Herman, Providers Becoming Payors]. 243. Ellison, supra note 172. 244. Kathleen Sebelius, The Affordable Care Act at Three: Paying for Quality Saves Health Care Dollars, HEALTH AFFAIRS BLOG (Mar. 20, 2013), http://healthaffairs.org/ blog/2013/03/20/the-affordable-care-act-at-three-paying-for-quality-saves-health-care- dollars/. The ACA created Accountable Care Organizations (ACOs) as way to incentivize providers to collaborate and provide coordinated care. Id. ACOs manage the cost of quality of patient care to ultimately reach of goal of improved care coordination and safety. Id. 245. Joseph Burns, Reform Forces Health Insurers to Reinvent Themselves, MANAGED CARE (Apr. 2012), http://www.managedcaremag.com/archives/2012/4/reform-forces-health- insurers-reinvent-themselves. 246. VALENCE HEALTH White Paper, supra note 240, at 1. 247. Margaret Dick Tocknell, 1 in 5 Health Systems to Become Payers by 2018, HEALTH LEADERS MEDIA (Aug. 20, 2013), http://www.healthleadersmedia.com/health-plans/1-5- health-systems-become-payers-2018. 248. Burns, supra note 245.