Value-based care is creating the need for organizations to focus on outcome measures, more personalized care and patient satisfaction, giving payers the opportunity to work with providers to solve problems with re-admissions and redundant care by sharing data that will result in lower cost of care for both parties.
In the past, payers may have met with provider organizations once or twice a year. Now, the two parties interact more frequently, including at the data sharing level, to improve operations and outcomes.
Improved health information exchange between the two parties is critical when they share responsibility for providing not only high quality care, but affordable care. Frequent and effective exchange can identify and address gaps in care, improve care coordination, increase preventive services and omit unnecessary duplicative testing and services – all of which play a role in potentially reducing overall healthcare spending.
A 2016 FierceHealthcare article cited two successful payer-provider collaborations – Trinity Health with CMS, and Inova Health with Aetna Virginia.
Trinity and CMS have collaborated on patient engagement and care coordination strategies to improve health and outcomes. Inova and Aetna created Innovation Health, a partnership that created simpler, more affordable health plans, including special plans for those with specific conditions such as diabetes.
Innovation Health also resulted in an enhanced care coordinator program where nurses from both partners meet daily to share information and develop care plans for members using hospital or ED services.
Healthcare sustainability, an insurance exchange in flux and VBID growth – in part through a current CMS demonstration model – can converge with gains being made from within the industry to further bridge the mutual goals and collaborations of payers and providers.