The American Association of Preferred Provider Organizations (AAPPO) held its annual forum in Florida in January.  The two hot topics - “ Evidence Based Medicine and Consumer Driven Healthcare,” two subjects worth discussing in this newsletter and future issues.

EVIDENCE BASED MEDICINE

PROVE IT!

"Quality isn't an accident, it is the result of intelligent effort." - URAC

Times are critical. You are expected to provide high quality care at "affordable" prices. But how exactly do you quantify quality so that health plans understand it; particularly when they are often challenging if certain services are even necessary? Better yet, how do you get health plans to agree on what constitutes quality?

During the AAPPO annual forum, it was clear that health plans and providers are at odds when it comes down to service and the bottom line. Health plans want to know what providers are doing to control costs and how they deliver quality care, while providers are wondering why health plans don't recognize their efforts with better reimbursements.

We have a tremendous opportunity right now to "bend the ears" of health plans, particularly in the PPO community. PREFERRED is well positioned within the AAPPO to help your voice be heard. If you are participating in the APTA's Hooked on Evidence program, please let us know by sending an e-mail to Hazel Valdez, our Director of Marketing at Preferred@preferredtherapy.com and indicate if you are interested in collaborating on an article to be published in our quarterly payor/PPO newsletter.

Watch next month's newsletter for a look into Consumer Driven ("Consumer Choice") benefit designs.