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Quality and comprehensiveness of patient care

Quality and comprehensiveness of patient care has to
be balanced across providers, as there are stricter regulations around utilization management. This includes
RAC audits and penalties for clinically inappropriate
utilization, preventable readmissions and hospital acquired conditions (HACs).15′ 16
Increased competition including retail clinics and competing networks has led hospitals to align with CV
specialists through employment, clinical integration
and narrow networks. This is in an attempt to build
regional referral sources, while providing higher quality care and controlling total costs.17 Hospitals are also
banding together to form national specialty networks,
creating a uniform patient experience and adhering to
standardized care practices in order to jointly negotiate
favorable payer contracts.
As cost sharing with patients becomes more popular,18
a robust patient engagement strategy including coordinating with community resources (wellness programs,
health coaches), nonfinancial gamification and financial incentives (e.g., lower copayments or premiums for
completing a health risk assessment) and disincentives
become necessary. Such strategies reduce employee
medical costs by approximately $3.27 for every dollar

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