[{"@context":"https:\/\/schema.org\/","@type":"Article","@id":"https:\/\/share-dev.upmc.com\/2021\/01\/premium-prevention\/#Article","mainEntityOfPage":"https:\/\/share-dev.upmc.com\/2021\/01\/premium-prevention\/","headline":"The Premium Is Prevention","name":"The Premium Is Prevention","description":"In health care circles, the notion of value-based medicine has been around for some time. Rather than a \u201csick care\u201d model, the thinking goes, we should move to a \u201cwell care\u201d one, where value and outcomes are the priority. The vision is tantalizing, but realizing it has been slow. Joon S. Lee, the Chief Medical […]","datePublished":"2021-01-05","dateModified":"2023-02-02","author":{"@type":"Organization","@id":"https:\/\/www.upmc.com\/","name":"UPMC","url":"https:\/\/www.upmc.com\/","sameAs":"https:\/\/share-dev.upmc.com\/upmc\/","parentOrganization":"UPMC"},"publisher":{"@type":"Organization","name":"UPMC HealthBeat","logo":{"@type":"ImageObject","@id":"https:\/\/share-dev.upmc.com\/wp-content\/uploads\/2019\/04\/UPMC-HealthBeat-Logo.png","url":"https:\/\/share-dev.upmc.com\/wp-content\/uploads\/2019\/04\/UPMC-HealthBeat-Logo.png","width":600,"height":60}},"image":{"@type":"ImageObject","@id":"https:\/\/share-dev.upmc.com\/wp-content\/uploads\/2021\/02\/UPMC_lee1-1.jpg","url":"https:\/\/share-dev.upmc.com\/wp-content\/uploads\/2021\/02\/UPMC_lee1-1.jpg","height":325,"width":754},"url":"https:\/\/share-dev.upmc.com\/2021\/01\/premium-prevention\/","about":["Health Topics A-Z"],"wordCount":398,"articleBody":"In health care circles, the notion of value-based medicine has been around for some time. Rather than a \u201csick care\u201d model, the thinking goes, we should move to a \u201cwell care\u201d one, where value and outcomes are the priority. The vision is tantalizing, but realizing it has been slow.Joon S. Lee, the Chief Medical Officer of UPMC\u2019s Insurance Services Division, which administers the nation\u2019s second largest provider-owned health plan, is challenging that status quo. \u201cOur health plan is transitioning from traditional fee-for-service payments to a system where getting paid depends on the outcome, such as lowering hospital readmissions or optimally managing co-morbidities like hypertension,\u201d he says.The centerpiece of this transition is a \u201cshared savings\u201d physician reimbursement formula that allows each practice to keep a percentage of the money saved from observing treatment guidelines to lower the total cost of care. \u201cMore than half of UPMC Health Plan patients are now under a shared savings contract,\u201d Lee says. \u201cWe expect that number to rise as we move it from primary care to the specialty side.\u201dLee is also looking at new ways to leverage UPMC\u2019s connection to patients to improve preventive health measures. He cites his experience in directing UPMC\u2019s Heart and Vascular Institute, one of the largest integrated cardiovascular delivery programs. \u201cA decade ago we began to see that, despite all the new technology, deaths from heart disease were inching up again,\u201d Lee says. \u201cWe were failing to control for risk factors linked to unhealthy lifestyle behaviors like obesity and smoking.\u201dIn response, the Institute worked with the UPMC Health Plan to create a patient-centered coaching program called Prescription for Wellness, utilizing UPMC\u2019s vast community outreach capabilities in managing heart care from a whole person perspective.Though there is much yet to be done, Lee says that in the end, integrated care is a puzzle where the pieces fit. \u201cThrough the coordinated approach we minimize expensive hospital care. But when it\u2019s necessary, UPMC offers the best there is. We meet the patient in the community to seed healthy behaviors, improve outcomes, and keep our insurance rates down. It\u2019s a trifecta win, for the payer, the provider, and the member.\u201dScientific American asked four UPMC leaders about how technology, science, and adjusted incentives are transforming the patient experience, and the future of medicine. This article is one of four interviews."},{"@context":"https:\/\/schema.org\/","@type":"BreadcrumbList","itemListElement":[{"@type":"ListItem","position":1,"name":"2021","item":"https:\/\/share-dev.upmc.com\/2021\/#breadcrumbitem"},{"@type":"ListItem","position":2,"name":"01","item":"https:\/\/share-dev.upmc.com\/2021\/\/01\/#breadcrumbitem"},{"@type":"ListItem","position":3,"name":"The Premium Is Prevention","item":"https:\/\/share-dev.upmc.com\/2021\/01\/premium-prevention\/#breadcrumbitem"}]}]